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r ..~..•~..~~ <br /> <br /> ' MINED LAND RECLAMATION DIV. N N D 1 7 9 5 <br />/ <br /> 1313 Sherman Street Room 423 <br />~ DenVer, CO $0]03 DATE 11 7~ 19 $ `~" <br /> (303) 866-3567 <br /> [[~~~ <br />RECEIVED FRDM u S~iG1 K.fiC~2,. ~~r~(' . <br /> O <br />THE SUM OF ~,~~. ~~ tf•R-- DOLLARS $ Sr~'CL <br /> ^ cns.+ <br /> FOR O~. T) ~1 `~. G - II I(rI 1 ~ pECK <br /> <br /> AMOUNT OF ACCOUNT...... $ <br />I <br />~ <br />~ <br /> ~/ ~U <br />~rr <br />~~ <br />AMOUNT PAID ................ $ Ste" <br />{ <br />4 BALANCE DUE ............... $ BY ~ ~ ~~ ~'.. • r ~ 10. r i <br />.~ <br />