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THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER AND ORIGINAL DOCUMENT SECURITY SCREEN ON BACK WITH PADLOCK SECURITY ICOK <br /> BANK OF COLORADO 4741 <br /> Progressive Agricultural Management Telebank: 1-800-295-6879 <br /> PO Box 445,518 Main Street www.BankofColorado.com <br /> Wray,Colorado 80758 <br /> 970-332-0604 82-244/1070 09/06/2019 <br /> PAY TO THE ORDER OF Colorado Division of Reclamation,Mining and Safety $ $115.00 N <br /> - - - - <br /> ONE HUNDRED FIFTEEN &NO/100 DOLLARS <br /> d <br /> Colorado Division of Reclamation,Mining and Safet <br /> 1313 Sherman Street., Room 215 <br /> Denver, CO 80203 B <br /> MEMO M 14D}02" M' <br /> Z°I J 9 5 0 0 1 AUTHORIZED SIGNATURE <br /> 1100047411in 1: 10700244816S10110SL, S11■ <br /> Progressive Agricultural Management 4741 <br /> Invoice# Date Invoice Amount Discounts Taken Balance Due Amount Paid <br /> 000735 05/31/2019 $115.00 0.00 0.00 115.00 <br /> Date: 09/06/2019 Paid To: Colorado Division of Reclamation,Mining and Safet Check#: 00004741 $115.00 <br /> Paid By: Progressive Agricultural Management, LLC <br />