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<br /> <br />Permittee Name: ReUdy M ~xc-~c~ C,-~ic~ ~ tE C-n. <br />Permit No: 77- 43ly <br />Operation Name: Tc1~JE= r ~t f <br />Anniversary Date:~u~)u~,{ 245 <br />111/112 Enclosure <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 />Division for annual fees due <br />~_ Annual Report <br />)( Map <br />Remarks: <br />/~`J <br />Signatdre <br />(Rev, 02/87) <br />5257E <br />~ ~ i <br />4i ' <br />