Laserfiche WebLink
• • III IIIIIIIIIIIIIIII ~ • <br />999 <br /> <br />Permit No: 80-3 ~~,u [ =-. =% --- <br />Anniversary Date: January 24 FtB ~ j X988 <br />.~.. - <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 far annual fees due <br />Annual Report <br />~~. <br />~ V~~~ C~~ <br />~ ~, <br />Signature <br /> <br />