REP40471

• Permit No: M1976007UG
• IBM Index Class Name: Report
• Doc Name: 110 & 111 ATTACHMENT
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

MINED LAND RECLAMATION DIVISION N~ 2 5 3 0
1313 Sherman Street Room 423 (' /
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Denver, CO 80203 DATF~~ -/(~ ~
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[phone]
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RECEIVED FROM _~ ~f Y _. ~ 1--1-~ ~_rl l• C.~t ~/ ~~ _
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THE SUM OF _~ / C r ____ DOLLARS $ /~ /_' _
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FOR../•_:~.._~/~~i7._r/ __`~ -., _ vc
AMOUNT pF ACCOUNT.... $
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AMOUNT PAID. ....... $ _. _ _ _ ~ _/ / /
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FJALANCE DUE ..$ ___ _ ElY ____ i.. ! ~/ 1. 4

33
INVOICE
NUMBER INVOICE
DATE DESCf ION GROSS DISCOUNT NET
3417E3 VENDOR CDLO MINED LAND RECL MATN CHECK DATE l0/JS/84
76-7 10/01/84 10-54 50.00 50.00

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DFC CERAMIOB INC. - P. O. HO% 110. CANON CITY. COLO. 81212