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~, ,~~-s, <br />Pe-;nit No: 77-560 <br />An^i versary Date: FebrUa <br />M.qR 2 !' 1980 <br />~ie~~gs~~"'0,,,~(l,iU~ f~.~rof 'R a.: ~,..~~ <br />~DeI2tOr: <br />Please comalete the following and return this form with your fees a;~d rec_anz- <br />tion data. <br />Enclosed are: (Check box(es)) <br />G'~eck or money order payable to Colorado Mined Land Reclama- <br />i ~ tion Division for annual fees due <br />Annual Report <br />Nap <br />ResarY.s ~~72~-H~- -~~_ <br />Signed, <br />~~~ ~- . <br />. ~~~~ ~ <br />~~~..~- <br />