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,--. <br />~_ ~II ~I~~I~~I~~~~~II~ <br />Permit Igo: 80-38 <br />Anniversary Date: October 1 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are:__(Check box(es)) <br />Check or money order payable to Colorado N~ined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />Remarks: <br />Signature <br />a~1~~~3 <br />om_~ <br />~~r_'~-'^1~~~ <br />f~~OV ? 1983 <br />I.ili~!=D I.GP!D RECLA.P.4ATIOP! Dlr/~~'^'jr <br />Cclo. Dep. of \atural Resour,.,.. <br />