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(~~~ # a a~s~ 3 <br />-- <br />Permittee Name: <br />Permit No: <br />Operation Name: <br />Anniversary Date <br />i~/as~ss <br />III IIIIIIIIIIIIIIII <br />sss <br />Gold Hill Mining Co <br />M-83-141- <br />CASH MINE <br />09 / 07. / 85 <br /> <br />110 and 111 Enclosure <br />T 7 3 1985 / <br />~~ <br />,..,: <br />CoVo. Dapi. of ;~_;~`e,u~ Rts~~urC.. <br />Please complete the following and return this .form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />_~ Annual Report <br />Remarks: IM;S pe2m:-}~ CJog s:~.b~ec-E -}o an A~pl.:cc~;r~n <br />~-n ~1me~dme.~t1- <br />(,JC1S a~Rc~r~+e.c~ Oll <br />~+embe~2 2l0 l~i85. ~ck;u:~;Gs 0.-i -Fke, Ccisin <br />m.n~ ~ut:na --I~e. l.as~- ye..ca.re. hn.~,c been l.:rn:~l <br />-~o u.nde~,cro,,~,,nct M~~~ de~e.c.oQrr.e~i- ~-nd -W~e_. <br />_omoLekion ok 0. ~econc~ 25c~~2-~- =--• -~RoM <br />-l~he. -~;2c~ ~e.ucl. o~ -iti.e M;na. _ Iher Co[~Si-~euc+:~~ <br />o~ c~. 50 - ~-on Pe 2 c{os ( ci2o~u:~y a.nc\ ~c.o{-a~~:on <br />Con c~ ~2.a•~-~oc~ m ~ ~c : ny ~`czc ; l :+y a..nd -~o:L; n~ <br />~ti-- <br />-k.e_.. ~m~ndmen-k- -~o -4ti.~ `3.si1 (l~:ne Lim:i-~c~ <br />:94_ <br />Signature <br />F~o(L : C-pcc\ t-(: `L 0(~-ta~2eS <br />L:sr•:-- eel '~a.1t~-r<e 2si~: P <br />