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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 />File Number ?fa2 <br />Drawer Number <br />Return Date IF <br />?,aaio <br />Received <br />Mailing Add <br />er <br />Mining and Reclamation Application for: <br />Name of Pit or mine: <br />Date on which <br />Applicant: ', <br />period is over and application may be retrieved by <br />7,/w ei-t- <br />Agent Signature: <br />For: <br />Attest: County Clerk or Deputy: <br />J,'69 Zs_