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<br /> <br />110 and 111 Enclosure <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />Mr. John A. McNulty <br />80-3 <br />January 24 <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 />Remarks: <br />Signature <br />