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t <br /> 110 and 111 Attachment <br /> Permittee Name: Kybato, Inc. <br /> Operation Name: <br /> Permit No: 77-468 <br /> Anniversary Date: June 16 <br /> Please complete the following and return this form with your fees and <br /> reclamation 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 /> I-I Annual Report <br /> Remarks: <br /> Signature <br /> (Rev. 5/84) <br /> Doc. No. 1782 <br />