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-.., <br /> <br /> <br />Permit Igo: 77-215 <br />Anniversary Date: October 31 <br /> <br />G~ECEIV~~ <br />O C T 2 419c,, <br />MINED LAND RECLAMAi10^' 9!!~rO1ON <br />Colo. Dept. of Natural k~~cw„~;, <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: <br />Remarks: <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />hlap <br />~~~ ~~ <br /> <br />Signature <br />