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ORIGINAL DOCUMENT HAS SECURITY FEATURES INCLUDING VOID PANTOGRAPH,MICROPRINTED SIGNATURE LINE AND SECURITY PAPER <br /> COMMUNITY STATE BANK 1143 <br /> WILLIAM F RATLIFF SPRINGFIELD,COLORADO <br /> P.O. BOX 38 82-736/1021 <br /> PRITCHETT,CO 81064 5/26/2023 <br /> DATE <br /> PAY TO <br /> ORDER HF DIVISION OF RECLAMATION, MING & SAFETY **11258.00 <br /> One Thousand Two Hundred Fifty-Eight and 00/100********************************************************************* DOLLARS <br /> ��^^��;r7DIVISION OF RECLAMATION, MING & SAFETY <br /> "ZV <br /> MEMO <br /> -� <br /> A THelilll SIGNATURE <br /> 110001L4311' 1: 1021,073641:110201006SO211' <br />