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III III III~IIIIIIIII <br />~~ <br />11 Attachment <br />Permittee Name: J & M Schmahl -,~, <br />Operation Name: <br />Permit No: t4-84-001 J ~ -~ `c :; <br />Anniversary Date: April 4 <br />Please complete the following and return this form with your fees a d <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~~ Annual Report <br />~=' Map <br />Remarks: <br />~.y~ ~~~. <br />(Rev. 5/84) <br />Doc. No. 1805 <br />MINEI AND RECLAMATION DIVISION <br />1313 Sherman Street Room 423 <br />Denver, CO 80203 <br />(30[13'),,,866-3567 R (~ ~(~(~/.J~ <br />RECEIVED FROM • , n n-~ ~^'r" <br />THE Sy/U~~M~,~OFu 1 <br />FOR ~[ML~1 ~-~' ~- -VD <br />AMOUNT OF ACCOUNT...... $ <br />AMOUNT PAID ................ $ <br />BALANCE OUE ............... $ B~' <br />_.J°_ 005615 <br />DATE ~B <br /> <br />^nna <br />~tiQf1{2 ~Ou~ <br />