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~ • <br />Permit No: 77- <br />Anniversary Date: April 30 <br />Operator: Cotter Corporation <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to the Colorado Mined Land <br />_ Reclamation Division for annual fees due <br />Annual Report <br />Remarks: <br />cT'l~f~ <br />Signature <br />