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.' <br /> <br /> <br />t <br />RCciVER <br />Permit No: ~~-223 <br />anniversary Date: January 25 <br />:IAN 2 61983 <br />MINED LAND RECLAMATION <br />COLO. DEPT. OF NATURAL RESOI:RCES <br />operator: <br />Please complete the following and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land Reclama- <br />tion Division for annual fees due ._ _„ <br />a ~ L• <br />.. .. ,.. '..~r..~ <br />annual Report <br />Map <br />Remarks <br />Signed; Q .~J <br />a/a-r ~3 <br />~.,~, <br /> <br />