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~~ <br /> <br />i <br />Permit No: 80-143 <br />Anniversary Date: October 27 <br />• <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed ar•e: (Check box(es)) <br />Check or money order payable to the Colorado Mined Land <br />Reclamation Division for annual fees due ~ 5~-~~!~ <br />i <br />Annual Report <br />Remarks: <br />Si <br />