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MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />Craig, CO 81625 <br />(970) 824-9104 <br />MINING/ RECLAMATION FORM <br />f <br />File Number l0 - <br />Drawer Number <br />Return <br />Received From 2? ?-? M o o rze_ <br />Mailing Address )Z70 2 fQ-10 iJ :n - i /-1, Q-e3 , ?8 I Z-5- <br />Mining and Reclamation Application for: <br />Name of Pit or mine: <br />Date on which inspection period is over and application may be retrieved by <br />Applicant: <br />Agent Signature: <br />For: <br />?M1.01 7 ?Sro <br />Attest: County Clerk or Deputy: