Laserfiche WebLink
. ~., <br />•, iiiiiiiiiiiniuiu <br />Permit No: 7 7' ~~' ~' <br />Anniversary Date: O' ~`-(.GC ~ 3 <br />Operator: <br />Please complete the following and return this form with your fees and reclama- <br />tion data. <br />•~ <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado ?;ineo Land Reclama- <br />tion Division for annual fees due <br />Annual Report <br />reap <br />Remarks <br />4'3 <br />~~ <br />E /lAtJr; AJD~ -~ 6G TTFIS DfY7C- ^~'A2TE~ ~uLL SC~L~E b~Ei'~71D-J OF <br />~7F~/S ~ r. easy/~U' oNE NG',Q~ h~-t 6ec~N ~I stay b1t ~ ~1 ~' ~JE F~•12E <br />NAT 13•T Fi '~D1ul T~iLLY' WG CoJ~d ~c~~u Y@~A+wA~IoW ~/'oGeSt. <br /># ntAV w'r2I uof be' ~o+~co-N~~,y. <br />Signed, ~~ <br />~d.,Q1 / ~,,~l,.o~,r; ~ <br />9~~~~~~~:~l~R°~ <br />.~ , .:~ <br />MINtU LAND R'~I;LA"~.`.!!GN <br />Co!c. Deot. o! 13i:r.:~ cesot n;r <br />