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.-~--~ =~ • iii iiiiiiiiiiiiiiii • <br />~« <br />Permit rto: _ 77-222 JAN 26 <br />x983 <br />Anniversary Date: Jdf1Ud Y'_y 25 <br />RIGED'pC~CLAµAiION <br />COLO DEP7. OF NATURAL RESOL','.CES <br />operator: <br />Please complete the followinq 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 - (l~'(/~ ~ ~/~~-{~}- <br />Remarks (~(,~ nntAd~ ~T 1 ~( ~ J"~p N J(_pJ.Q~ <br />Signed `\ /~_ ,~~~ <br />a~~-~~3 <br />~ ~~ <br />