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_~ ~ ~ III IIIIIIIIIIIIIIII` ~/~/~Z- <br />Perini. t No: 7 7- c~ <br />Anniversary Date: o+', ~ <br />Operator: <br />Please complete the following and return this form with your fees and recIama- <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 />TTA~he ~~ i s .¢ C' opv~ o-I' Yr~ N /~ T~~2 '-rh a T w .4 s <br />~~ <br />~,v 7 R /a ,v ~ ki i-~ own. ~.I~c. .n-. /- .2 ! - $ Z. <br />f1 ~su 2 c~A-/lr ~f X70. zgr h ~,~d. a,.. ~-.~- ate, / .Nv <br />sue; d ~ z ~ ~ d ~~~~ 4....d ~AU..,..,~ ,~...,.- .~~. Q..~ ~~~~ . <br /> Annual Report <br /> hap <br />Remarks ~e~P c <br />d«'S' . <br />A <br />Signed, .~/` <br />U Ly D ~ ~_ <br />ti* .~... h o,,, , <br />M~•~ ~ is 1982 <br />MINED LAn!D ~4EC!.A;~%p,rION <br />Colo. Dept. of Na~ural Resource° <br />