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~~ <br /> <br />Permit No: 78-283 <br />Anniversary Date: April 24 <br />Operator: <br />~ iiiiiiiiiiiiimiii <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />Remarks ~ '! / S ~ / ~ / 5 / /ti ~ /1'' ~ ~ ~ C y <br />Fr' n1 d ~f ~ ~ 7 r,LH T r 5 /i 1 /.~.' e d ~ s ~ ~9 n1 d , <br />j`~Cvr~ lnJfr'TC~S rrtL e d This ~c7~9~ K <br />//~ RccFVn?AT~o~i ~i/~~~ss.sRY NT ltii$ <br />Signed, `~~' //~ ~j <br />`tj3p/fSa <br />b. K _ <br />~. <br /> <br /> <br />~OI~ ~C.~r ~ c:i4"''. r <br />