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• III 1111111 IIIIIIII ~ <br />hermit No: II1-207 <br />anniversary Date: February <br />Operator: <br />Piease complete the following and return this fOZTt;Jith yaur fees ar.d -__-_a.rc- <br />tion data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land Reclama^ <br />Q tion Division for annual fees due <br />G , P ~~ ori7 c.~ S ~r f ~Z/& 3J ~~ ~vrs5 <br />Annual Report <br />:aap <br />~e.~a mks <br />s'^._a <br />