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__ . ~ III IIIIIIIIIIIII III ~ `~°•`~` <br />Permit No: 81-107 <br />Anniversary Date: ~ditUdry <br />Operator: <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (Check box(es)) <br />eck or money order payable to Colorado Mined Land <br />Reclamation Division far annual fees due <br />Annual Report <br />Signed, <br />JAN 2 41983 <br />MINED LAND RECLAMATION <br />COLO. DEDT. OF NATURAL RESOURCES <br />