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~. <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />iii iiiiiiiiiiiiiiii <br />999 <br />110 and 111 Enclosure <br />• <br />DEC 6 }~ <br />Colonna & Co <br />M-77-144- <br />MICA LODE <br />11 / 30 / 85 <br />• <br />~ECE11fE~ <br />MINED LAND RECLAMATION <br />Calo. OepL of Natural Resources <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) -- <br />x Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: We have not this year, and do not anticipate next year to exceed <br />permit limits. <br />Claim Still active. No reclamation planned at this time. <br /> <br />gnature <br />