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• • iii iiiiiiiiiiiiiiii <br />Permit No: 77-53 <br />Anniversary Date: December 23 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />xx Check or money order payable to the Colorado Mined Land <br />_ Reclamation Division for annual fees due <br />_ Annual Report <br />Remarks: There currently are no mining activities taking place on the mine <br />te. <br />:/ ! <br />s <br />'G~f~/ <br />' ~~ /~ ~~ <br />~; l c. <br />i <br />e n", d q.~ F°~, <br />~~.~,L, . ~_._~ <br /> <br />rSInIFn u~n>> rrc!; ....:,i10;; ~;"!`,~IOn <br />(•n~,i, i)n~l'. !'1 b'ati.i :': ji~~0 dfCC5 <br />