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IIIIIIIIIIIIIIII <br /> Permit No: 77-315 <br /> Anniversary Date: April <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 /> tion Division for annual fees due <br /> QAnnual Report <br /> Q Map <br /> Remarks N e I p_e�.�, e.✓ t' o.✓� . <br /> Signed Z <br /> CsS. <br /> . ri. <br /> APR 19 1983 <br /> MINED LOU <br /> ,o!o Dept. of Nlatui@I Resourceo <br />