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..- M i <br />Permit No: 81-57 <br />Anniversary Date: June 10 <br />Operator: Berthoud Pink Stone Co. <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 the Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />L <br />