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MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />Craig, CO 81625 <br />(970) 824-9104 <br />1 <br />11?7,,oAiratT 7R <br />MINING/ RECLAMATION FORM <br />File Number, <br />Drawer Number, <br />Return <br /> <br />aV *1 bolo <br />Date l (Qj O'? ?? o? ??1? <br />Received <br />Mailing <br />61 <br /> <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: ?.9L-1A- ??r?lD?n 5Stdal 42,? <br />Attest: County Clerk or Deputy: