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r v - • • i <br /> 111 IIIllllllllll 111 <br /> 110 and 111 Attachment <br /> Permittee Name: Russell Naasham <br /> Operation Name: <br /> Permit No: 77-500 <br /> Anniversary Date: June 29 <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 Colorado Mined Land <br /> Reclamation Division for annual fees due <br /> Annual Report // _ �// <br /> y (icyl - /I ae /7l.n i rA O�,eIZ2 "A4 S <br /> Remarks: ct) olio /v4rl alas' Jeff e�Cesf+�u ^ "n9 <br /> /J/) /T -e4x ec9 fu '+ jmz� <br /> A7..�i, <br /> RECEIVED <br /> Signature' � Al.)G ) 0 1984 <br /> (Rev. 5/84) A} 1 <br /> �,/96¢ MINED LAND RECLAMATION DIVISION <br /> Doc. No. 1782 Colo. Depi. of Natural Resources <br />