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• ~.~ <br />Permit No: 81-14 ROZMAN PIT <br />Anniversary Date: June 29 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed a/re: (Check box(es)) <br />Check or money order payable to Colorado <<lined Land <br />Reclamation Division for annual fees due <br />Annual Report ,~,/Ow . ~,, <br />_ Map ~~~ 51983 <br />// MIR~nD LAO N9~u aA4esourOce` <br />Remarksl~:JJ ~~~ T//e2e u/aA-S //o Q~CA/-2cTica fo~~~Ci~~"~p~C eye-e <br />/// Th i~5 PLr 7~if ~,sJT ~e~4/' 0// ~uNe o ~7-~i T"! b 3 U/2 SiR~2Te~ <br />S/a~~ ~ y ~ /I ~o c, ran ci cl e e~7~~.e Pr r A,/c~ ,~u c/,/N4 ~ Prr 2c/,/ <br />~( fI t n/ A- ~~ 1 ~ iN Ce.JTea o ~' Per 'To Se !/ _ <br />''// / , <br />(?~ NU ~2C~1,4~rJ.¢T/vN a~aue_ eJ(fedT wrya'T a.JN-S o/v <br />~. <br />Signature <br />N /J <br />>~~~~ <br />