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Permit No: 78-208 <br /> Anniversary Date: June 16 <br /> Operator: <br /> Please complete the following and return this form with your fees and reclamation <br /> data. <br /> I <br /> Enclosed are: (Check box(es)) <br /> Check or money order payable to Colorado Mined Land <br /> Reclamation Division for annual fees due <br /> Annual Report <br /> Remarks <br /> Cole. Dept of <br /> Signed, <br />