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~ III IIIIIIIIIIIII III ~ <br />110 Enclosure <br />Permittee Name: Colorado Bank and Trust <br />Permit No: M-78-304 <br />Operation Name: Black Cat Pit <br />Anniversary Date:ll/13/86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) Del ow) <br />x Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br /> <br />Signature <br /> <br />