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<br />Permittee Name <br />110 and 111 Attachment <br />Operation Name: <br /> <br />Beaver Brothers <br />• iii iiaiiiiiiiiiii iii <br />999 <br />RECEIVED <br />Permit No: 77-443 NOV 231984 <br />Anniversary Date : November 8 MINED LAND RECLAMATION DIVISION <br />Colo, Dept of Natural Resources <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Ix`XI Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />I,I Annual Report <br />Remarks: Please be advised the Annual Report and Map will be submitted <br />to your office by no later than December 20, 1984. I am enclosing our <br />Check X110508 for annual fees due at this time. <br />J <br />(Rev. 5/84) <br />Doc. No. 1782 <br />