Laserfiche WebLink
,- <br />Permit No: 77-443 <br />Anniversary Date: November 8 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to the Colorado Mined Land <br />-~ Reclamation Division for annual fees due <br />_ Annual Report <br />--~ <br />Remarks: <br /> <br />Signatu <br />