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- 4 ~_ - <br /> <br />I II III III IIIIII III I <br />~ ~ d/~ <br />F~ <br />Permit No: 78-349 <br />Anniversary Date: December <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Entlosed are: (Check box(es)) <br />X Check or money order payable to the Colorado Mined Land <br />_. Reclamation Division for annual fees due <br />_ Annual Report <br />Remarks: [de did not mine in 1983, and due to economic circumstances in this <br />area it is not known if in'ng '71 h necescary 'n 19R4 <br />Signature <br />~~~~~~~~ <br />DEC 9 i983 <br />[~i1NED LNND kECLAMATION DIVISIOPI <br />Colo. Dept. of Natural Resources <br />