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•,... <br />~ IIl Illllllllllll 111 <br />• <br />~~~`Er~d's6re <br />• APP, 81988 <br />Permi ttee Name: Benson Brothers ;b~:IV~J L.AN4, <br />Permit ND: M-77-062 REC~A~.YA'Ei01V GIVISIpN <br />Operation Name: Hallenbeck Pit No 1 <br />Anniversary Date: 04j02/8B <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Chock_or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: jar- g~/o~l,,.~ <br /> <br /> MINED 1`D RECLAMATION DIVISION ~_ 007820 <br />1313 Sherman <br /> Denver, ColOredo 80203 DATE ~ _ 'k 19 k <br />(303) 866-3567 <br />RECEYVED ~~ ~ $ ~' / J~ <br />FRDM 1~2.~/~1-11. Yl ~-~C~~ ^.~ _ ~ c. t ~ „ t (-' <br /> ~ DDllARS <br /> <br /> j (~,~ O CASH <br />FOR _ ~ ~. ~ 1, ~ I X-a( ~ ~ Z ~(~ C~~0."GFiECK <br />^ M.O. <br /> <br /> AMOUNT OF ACCOUNT...........$ ('p~ <br />f <br />' <br />) <br /> ~N ~ JOU <br />AMOUNT PAID .... ... ...... ...$ <br />`, <br />/ <br />BALANCE DUE . ........... .... ...$ BY '~' ~~ <br /> <br />Signatu <br />727Bc <br />0052f <br />