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_. ~~~ ~ ~ • III IIIIIIIIIIIII III <br /> <br />Permit No: 81-112 <br />Anniversary Date: September 1 <br />r <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 Colorado Mined Land <br />_1 /Reclamation Division for annual fees due <br />v Annual Report <br />~~ <br />L~^ <br />///~~'~. <br />oil I .fr p~ - <br />Si <br />RECEIVED <br />SEP 61983 <br />MlNEO ~0 RECU~M~~1O-~ OIV~ON <br />Colo. pepti of Na;u~a~ Nesc+~ <br />