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.~-- <br />_ ~-_~ <br /> <br />Permit wo: 77-301 <br />Anniversary Date: October 27 <br /> <br />Operator: {/ <br />PZease complete the foIZowing and return this form with your fees and recZama- ' <br />ti on data. <br />Enclosed are: {Check box(es)) <br />Check or money order payable to Colorado Mined Land Reclama- <br />Q ti on Division for annual fees due <br />Annual Report <br />Map <br />Remarks Annual reports and map to follow <br /> <br />Signed, <br /> <br /> <br />NOV G -~ 1382 ~ <br />MtNE© LAND HtC,A,~IAT10N <br />Q!!A pept. of NaU,ru NesourCe~~ v <br />