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~ ~ ~ III IIIIIIIIIIIII III ~ ~,~~~ , <br />~ ..~ a 1 <br />:r _ -" _ <br />Permit No: 81-75 <br />Anniversary Date: July 30 <br />"1' ~ ~ 1983 ~ <br />Mln"E~ LA.i~1D iIECLd~lA710iV <br />Colo. Dept. of P!aturai Ilosx~rcer <br />\ Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check bon(es)) <br />Check or money order payable to Colorado Mined Land So <br />Reclamation Division for annual fees due <br />_ Annual Report <br />Remarks: ~ `ice„ ~Q~im.~ 1F-Co 1~~irJ ~ytii~~ <br />J~ r <br />~~~?~'vi ~ZP. ~i-L~.L~ /.d'~Z~-~.l~lzl i%2~ G~ X~Q~ <br />~i~m . ~/9Lj te~l~ <br />G ~ <br />vy~« PS S7atiF cornP~N/ <br />Siy tur <br />