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*.'~ '~ <br /> <br />RE~E'~I~E~e <br />Permittee Name: Hendricks Mining Company NOV Z 7 }~ <br />Permit No: M-77-410- <br />operation Name: MINEOUINDRECLAMATION <br />Anniversary Date: 11 / 03 / 85 COb.DIpt.0lNeturalNMOUrCes <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />ti Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />~ Annual Report <br />Remarks: <br />Signature <br />