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1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />112 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br />Cripple Creek & Victor Gold Co <br />M-80-244- <br />CRIPPLE CK & VICTOR <br />04/09/86 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />X Check or money order payable to Colorado Mined <br />Land Reclamation Division for annual fees due <br />X Annual Report <br />X Map <br />Remarks: <br />Signature <br />