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• „ iii iiiiiiiiiiii iii <br />Permit No: 77-317 <br />Anniversary Date: December 15 <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 the Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />Remarks: <br />I`~~~9"In~~ <br />v ~ "~' <br />~E~ 14,~,;,~ <br />Goh~. D~„~. ~, ,r~~ural ke.,,,,~,;es <br />