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III IIIIIIIIIIIII III <br /> 999 <br /> Permit No: 77-315 <br /> Anniversary Date: April 23 <br /> Operator: <br /> Please complete the following and return this form with your fees and reclama- <br /> tion data. <br /> Enclosed are: (Check- box(es)) <br /> Check or money order payable to Colorado Mired Land Reclama- <br /> tion Division for annual fees due <br /> Annual Report <br /> Map <br /> Remarks <br /> Signed, <br /> 7 /ZG/�o2 <br /> APR 2 d 1982 <br /> MINED LAND RECLAMATION <br /> CO!^. Dcot. of r'Vur21 <br />