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~. <br />~~~s • • Illllllllllllllllll <br />999 <br />Permit No: 77-327 <br />Anniversary Date: Februa <br />/~Ar~vE <br />Operator: <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />XXX Reclamation Division for annual fees due <br />XXX Annual Report ; <br />Remarks <br />a. Cand abbeeted diuung S~th yeah - i/8 acne <br />b. .Card .ta be abUec.ted dwi,i.ng .tbie 6#h yeah .ih <br />anti.ci prated .ta be i l ~ ~~ 1 /4 acJceb . <br />c. no Cand wcv, necCcLimed duR.i.ng -the 2aa.t yeah. <br />Signed, / <br />~! ~ ~~ <br />J p6 C. UleP,te <br />~ e Paeh.Lden~t <br />E SUh1MIT BRICK & 7ILE CU. <br />~tl ~-~ ~~3 ~~' <br />~^ <br />