REP41459

• Permit No: M1981277
• IBM Index Class Name: Report
• Doc Date: 1/11/1988
• Doc Name: ANNUAL REPORT FORM
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

MINED LAND RECLAMATION DIVISION ~-- N~ O O 7 3 6 O
1313 Sherman, Room 4]3
' Denver, Colorado 80]03 DATE ~+s
[phone]
RECEIVED FROM ~il i,~~{,Le~I '~>,rC~~ l~
THE SUM OF
~ ~ ~~ DOLLARS $
~~
~~
Q
q
r-

AMOUNT OF ACCOUNT.... , , $
kan1~ oul
AMOUNT PAID ................ $
BALANCE DUE ............... $ BY~9C'll0 ~ ~ t' ll0 ~ ~