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<br />Permit roo: 77-559 <br />.y::niversary Date: February <br />RECE!lIED <br />FEB 191987 <br />MINED LAND <br />RECLAMATION DIVISION <br />Ooerator: <br />Please complete the following and return this form with uo::r fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es)) <br />Remarks <br />Check or money order payable to Colorado Mined Land Reclama- <br />ti on Division for annual fees due <br />Annual Report <br />Map / <br /> <br />Signed, <br />;\~~ ~~~ <br />o~'~ <br />W~ ~~~~~~ ~~ ~ ~ <br />a ~a 61a~~ <br />Gm~~~°~ <br />r~~~ <br />__- <br /> <br />