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M-1983-122 ~/ ~~® <br />OCT 012003 / <br />diYidfdll CI f3111dfdid ddd Rdd~dOV <br />MADAtETY I YN7RATE5T I I ~ PAMCt1NT I IAItO N~ I 6A LAbbCE <br />Statement 02 310472 06 <br />FCCOUNT NUM2ER <br />STATEMENT GFTE ~_`; 0-2003 <br />PnGE <br />77215 <br />ALL EARNINGS TOTALING $10.00 OR MORE WILL BE REPORTED TO THE IRS. KEEP THIS FOAM FOR YOUR TAX RECORDS - DO~NOT DETACH THIS FORM TO YOUR INCOME 7AX RETURN <br />STATE OF COL~RADOIMlMfD LAND RECLAM <br />PDPA AOI000t00S1fli Al <br />faDeeas .~ EIDER ~aaMTOR N0.077215 <br />1313 SIiERMAN ST ROOM 215 <br />DEMYER CO 80203 <br />NOT NEGOTIABLE <br />PLEASE ADVISE US OF ANV CHANGES OF ADDRESS DIRECT iNOUIRiES To: DETACH BEFORE DEPOSITING <br />DEI AGM 739-539-2536 ~ GH REH <br />HERE ~ <br /> $811de <br />5p t~ W.2tM $t <br /> sauea co <br />i~ <br />~i <br /> <br />$ <br />tr , _ <br />tom' err „.i ~z ~ ~r.~'~ %q ~'z"". <br />Y TO THE;~t~ a S,kTA,~TE ~~~ -CCUI,,;~lADO1M3NE D;Dta3 .A <br />oER OF I`+F RZ#+A tt'01,gpli'!"O B1 U1 ~ "~~~~ <br />a., +.t R..-x y-~, <br />.. ROBERT'-1"" F'r nESt 6AdAWTOR ' <br />1313 SHERMAl+! ST - Ei00i1' 225 <br />MADE PAYABLE ONLY TO: <br />Robe E/~ld~e~r~ ~ <br />v~i$~:~LG!/ ~ / <br />RONALD W, CATTANY, Dire or <br />Division of Minerals and Geology <br />Offica of Mined Land Reclamation <br />State of Colorado <br /> - ~o. O7 1 2~ <br />-csark?s,. c.°"o <br />"¢,,,?^¢-r <br /> <br />ssit'~e ;~zri~ '~"'ar; <br /> 02 <br /> <br /> <br />&Aau> 'p'~+i i'-~z+ <br />82 - ]Od8 ~~ .' <br />9ULta. <br />"a`~" ~ - 4 <br />CIE <br />