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iX %-I1„ <br />United States Department of the Interior <br />Bureau of Land Management <br />[)IV OU SUI)PORT SERVICES <br />_'S50 YOI NGFIh.LD STREET <br />I.; \K,IAVOOD. ('O SO2 15 -7076 <br />I'Iwnc: ( 303) 239 -3600 <br />Transaction #: <br />Date of "Transaction: 08 26-2013 <br />CUSTOMER: <br />,l MARK, KRIVANI:K <br />415E21'NDSI' <br />SALIDA,CO 81201 -2809 (1S <br /> <br />Receipt <br />No: 286=1489 <br />LI <br />QI'1' <br />DESCRIPTION <br />R KS <br />#N <br />CHE('K RECEIVED: 08/26/2013 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />('HECK NO: <br />NAML: <br />KRIVANEK JEWELERS <br />101 F STREET <br />SALIDA CO 81201 US <br />REMARKS <br />I his receipt \c &, Lac rncrated by the autonlated 13L ill ( ollectums and Billing System and is a parer representation of a portion <br />,)I the olyclal electronic tccord contained therein. <br />!hill' ch, hlnt.t!o\ ;thin dh,�h /order 8 26;2013 <br />