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1 • <br />~} I I <br />I <br />,II ' <br />Permit No: ai_~ <br />' Anniversary Date: April 27, 1984 <br />I <br />i <br />r...~ .~.~ ~~ <br />Operator: <br />~ Please complete the following and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es)) <br />i <br />~ Check or money order payable to Colorado Mined Land Reclama- <br />Q tion Division for annual fees due <br />0 Annual Report <br />Map <br />Remarks <br />See Attached Letter/Report <br />i <br />Signed, <br />Ted L~. Hanks• <br />Vice-President <br />I <br />