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<br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date: <br /> <br />Kelmine Corp <br />M-77-284- <br />MINERAL JOE CLAIMS <br />06/ 16/85 <br /> <br />110 and 111 Enclosure <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />i7 <br />r <br />$1 <br />S~ <br /> <br />_~ Annual Report <br />