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003397 <br /> Chamberlain Enterprises, LLC82-293/1021 <br /> 29242 C�o Rd 35p ray State Bank <br /> W ray, CO 80758 300 Clay St•PO Box 277•Wray.Colorado 80758•(970)332-4111 <br /> (970)332-4355 <br /> DATE 03/06/2024 <br /> ORO TO <br /> Division of Reclamation Mining and Safety $ **2,696.00 <br /> Two thousand six hundred ninety-six and 00/100**""*""*"""""'*"""""""""*"""`*** .`."**"**..""*`* " DOLLARS <br /> Division of Reclamation Mining and Safety <br /> 1313 SHERMAN ST, ROOM 215 <br /> DENVER, CO 80203 USA <br /> ti\-Z Ot o -OLS enth, Ghat a,;n <br /> MemcCis1/4\ I <br /> t AUTHORIZED SIGNATURE <br /> Rte' ����� <br />