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• <br />. , <br />Permit fro: 77-301 <br />Anniversary Date: October 27 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: <br />Check or money order payable to Colorado Mined Land <br />_ Reclamation Division for annual fees due <br />- Annual Report <br />_ flap <br />Remarks: ,J'I.hh~~~.C J1fi7o1'~'S.- ~aN,e, Sw~~W.A ~~IT 83 <br />