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r - • • • <br />III IIIIIIIII'IIIIII '++' <br />sss <br />Permit No: 7 - /S ) <br />Anniversary Date: ~~ <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 />Check or money order payable to Colorado Mined Land Reclama- <br />® ti on Division for annual fees due <br />Annual Report <br />Map <br />Remarks ~LERSE CvRRE[7 /)u~z YYI.7~L/~llJ !-1DDR6SS /D. <br />J~ArNSOU,P b~7eoTHERS, SwIC. <br />~SoB l~o. u.S. 1-~-JY. gS <br />RARdSO"JR BF;OTHEP,S, INC. <br />Signed, <br />r~ ~„ ti i ~~l~ ~~~ <br />e `a~~ <br />~v ~ a t9a2 <br /> <br />tv11NED tAo ~1aEu(ay~a°so O~e~ <br />Co.o. Dep <br />