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~I~ II~~I~~I~~~~~~I~ <br />999 110 Enclosure <br />Permittee Name: Richard D Mott <br />Permit No: M-80-049 <br />Operation Name: Mott Gravel Pit <br />Anniversary Date: 02/18/88 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />- - - Oi vi s i'Jn-far annual-fees-due- - -- - - - <br />v <br />Remarks: <br />Annual Report <br /> <br /> MINED LAND RECLAMATION DIVISION ~J ~ 0 0 7 4 6 5 <br /> 1313 Sherman, Room 413 <br /> ~-' /J <br />Denver, Colorado 80103 , 1 DATE ~ Z ~s <br /> .866-3567 - <br />(3003) <br /> 1 <br />RECEIVED FROM MI~~~ <br />~~~ <br /> ^ <br />~/ <br /> /} <br />e <br />) <br />THE SUM OF <br />vV DOLLARS $ n~~ / . <br /> ^ Cn9-i <br /> ~ECK <br />FOR C7~nM <br />~fl ~7•~~'t ~s y UM.o. <br /> ~(/7 <br />AMOUNT OF ACCOUNT...... $ <br />h{2 ~OUI <br /> AMOUNT PAID ................ $ <br /> BALANCE DUE ............... $ BY <br /> <br />(Rev. 02/87) <br />5257E <br />~~ <br />