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-1983-122 ~~® <br />ocr o ~ ~ <br />Divhlen G(Iglaarah and geology <br />NADATE'Y I INAAT€ST I I I PANOUNI I 1A ND UN TT 4 BA LANtE <br /> #######. 00 #####29.96 .###3.700.00 <br />Statement <br />ACCOUNT NUMBEF <br />Si4EMENi OAiE O9 ~ ~ 2Q D3 <br />Gn.GE <br />T 72 25 <br />ILL EARNINGS TOTALING $10.00 OR MORE WILL BE REPORTED TO THE IRS. KEEP THIS FORM FOR YOUR TAX RECORDS - DO NOT DETACH THIS FORM TO VOUR INCOME TAX RETURN <br />STATE OF COLORADO/MINED LAND RECLAN <br />PDPA No. X77225 <br />AQBERT~L,ELDER GRANTOR <br />1313 SHF.RNAN ST ROOM 225 <br />DENi/ER co 80203 NOT NEGOTIABLE <br />PLEASE ADVISE US OF ANV CHANGES OF ADDRESS DIRECT INQUIRIES To: DETACH BEFORE DEPOSITING <br />D ER8 • ~ 729-534-2526 ~ OM RED 7 <br />y .. - - - - 82 ]068 . <br />3021 <br /> Home ONke Salida O 7 <br />N0 , <br />~ 2 ~~ <br />Htgh~'otantcyigl~lulc~s;~3B0~""""s~ ,soWa,asL <br />Salida. CO <br />aBda" <br />~Q~ a~~P <br />a 6~.~, <br />$~4u" . <br />~~„ 1 <br />~"~t . <br />~d 1~ <br />~'SaS <br />~ <br />R <br />~ <br />rw <br />at ~ oodP i <br />N <br />~~ <br />kt 4 ~'"'~~z <br />' .~ <br />a <br />&°^"$ . <br />xWak' .. <br />x~ ~ <br />j <br />gg <br />- Sx~9'S ~Y SI <br />~A y Ad S ~"5 . <br />~RW_ >Z.E9y @[64@ 4g~ r~i g B <br />021149 - 0;~ <br />iRP" 9 w {mss ~Yfa x(5^2 tq° 'i#i~~ *#!~yd' .at <br />a. <br />i4}px a;E$+'r ~*L`:': ~#~t ~aS^ '~4LS 4~;~Zt z <br />.>~ (~~ <br />~ <br />~ <br />I .~ 6 ~ - ~S'mt3 +Pyff AR~4'" L74"~G iH;~C a&&3~r 4 6 i .-8'~. <br />- <br />u?a <br />- <br />~, Ats .,. EtlgvR• '~'yyy., ~;y' .. +~~PH ~~3t4 ,AK~~ ,.i <br />~:%~_ <br />` d'rylr~ - d~~^v px,:.t7aaag~~~~ - - .~}&;#;`.4l 1'd~ySfkJ :~iS~o` ~tr <br />..:~-_..._ _.zrc-iy ~:*~ _i....,._- ~ _ .~..,+:- <br /> <br />...: <br />AtfBERT L t=1D€R +G&1~AfTt3A <br />~13i3 SHERNAN ST~ROON~225 <br />DENytER CO 80203 <br />v'EBwi~" saw' "r <br />II II ; 1. <br />MADE PAYABLE ONLY TD: <br />e L~./~jH~ld~er <br />jL,eita~iat/~.~i!%~ <br />RONALD W • CATTANY, Director <br />Division of Minerals and Geology <br />Office of Mined Land Reclamation <br />State of Colorado <br /># <br />