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.. ~~ =. <br />n <br />U <br />Permit No: 77-132 <br />Anni versa rc: Date: ~dnUd Y'y <br />Operator: <br />n <br />U <br />Please complete the following and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land Reclama- <br />tion Division for annual fees due <br />Annual Report <br />Map <br />Remarks <br />Signed, ~ <br />RECEIVEp <br />FEB 0 21983 <br />CO{q~ ~EP'f - 1'U U7 Rglil RESOURCES <br />