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<br />DATE
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<br />MARGARET J. ALT, GRAND COUNTY TREASURER' i ; ~\ -;
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<br />.t REFERENCE NAME ADDRESS
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<br />~~ RIP(~Q
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<br />LEVY` ?:' FIRST HAL •~%IAST AUT .. T
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<br />Dell n uent Maren is Iln usnUAupust to , Delln n Mi
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<br />PRINT ADDRESS CHANGE CHECK
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<br />~ INTEREST
<br />rOUR CANCELLED OR NEW OWNER HERE . I
<br />1 '
<br />CXEL% ,5 YOUR
<br />BEST RECEIPT. AHD
<br />CASH ~ `
<br />SAVES YOUR 1AI
<br />OOLURS i0 OB-
<br />TAIN A RECEIPT.
<br />YOU MUST RETURN
<br />BOTH CORES AND TOTAL RECD
<br />LN
<br />E ^
<br />ELN HER
<br />~ TOTAL REFUNDED TOTAL PAID
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