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To Division of Minerals 6 Geolog <br />NAME GP F9lM G0. PERSON SUPPLYING GOOOS ON SERVR.'; <br />IN ACCOUNT ~VI'CII <br />COIUNTY OF BACA <br /> DESCRIPTION AMOUNT <br /> Annual pit fees <br /> Pit 4131 (M93-088), Pit 1132 (M95-019), <br /> Pit 1121 (M82-019), Pit G22 (M82-032) 1~225:~00:~_`•: <br /> <br />STATE oP COLORADO L ss. I do solemnly swear that the several items mentioned in the annexed accounts <br />cG~~ly Gr saga J <br />are just and true, that the articles furnished, that the labor was performed as herein chazged and that the sum <br />Of One Thousand Two Hundred Twenr~iva and 00/100-- $ 1 975.On <br />the amount claimed, is due and unpaid. <br />Subscribed and sworn to before me this Slgn Here <br />19th day of April 19 99 <br />n <br />y ~ND~YPl1BL1C OR~ADW.NISTRATIVE ASSISTANT <br />CITY OR TOWN STATE <br />