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<br /> <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br /> <br />Holly Sugar Corp <br />M-77-303- <br />Sectian 16 fir- i <br />03/01 /85 <br />h: - ... .. <br />~ - . ~_. <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Y Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />r~ Annual Report <br />Remarks: <br />~~~ ~- <br />Signature <br />