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~-. <br />~~ <br />Permit No: 80-248 <br />Anniversary Date: February 4 <br />Operator: <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (ChecY. box(es)) <br />Check or Honey order payable to Colorado Pfined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />Remarks <br />Signed, <br />~~ <br />