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MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />Craig, CO 81625 <br />(970) 824 -9104 <br />Attest: County Clerk or Deputy: <br />MINING /RECLAMATION FORM <br />File Number /- <br />Drawer Number <br />Return Date Lo ✓V1014 S <br />Date 7-:31-1 I <br />Received From <br />Moo <br />Mailing Address ) c <br />0 cAst / (e) "8 l (4. <br />Mining and Reclamation Application for: f r. ) cs..`f )1 0p:-- 1 �`� � i �"" � 0 <br />Name of Pit or mine: 1— i M E=S n 11._ P+? ( d <br />Date on which inspection period is over and application may be retrieved by <br />Applicant: 1 - e rt-t 5 <br />Agent Signature: <br />,J 1 or Cw'oT <br />For: Mcp f t -'r <br />e.o' --1 ,...4!SS rokL! 2 C <br />