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+~ • ~ RECEIVED <br />MAR 14 1984 <br />CATf[A rn~onge%iN <br />Permit No: 77-305 <br />Anniversary Date: March 31' <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />JC Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~ Annual Report <br />Map <br />Remarks ~'/h.1..,.,. o <br />Signed <br />