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<br /> <br />Permit rJO: 77-322 <br />Anniversary Date: Z'ebruary 17 <br />Operator: <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (Check box(es)) <br />Check, or money order payable to Colorado l4ined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />• Remarks <br />Signed, <br />L J <br />