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14 <br /> THE INSURANCE STORE, INC. <br /> 845 10th AVENUE <br /> -- — SUSNEY;IVEBRASKA 69162 — -- — — _ <br /> Phone: 308-254-2224 Fa:: 308-254-2229 R E C:E I V <br /> OCT � 22001 <br /> Invoice No: Division of Minerals and Geology <br /> Date: 8/30/01 <br /> Company: ALLIED Policy#: SD0000601208 <br /> Eff. Date: 8/1/01 Exp. Date: 8/1/02 <br /> Name: GAIL C & MILLIE J ALLEN <br /> Address: 68075 CTY RD 'i 09 <br /> City: GENOA ST: CO ZEN 80818 <br /> Debit Credit <br /> RECLAMATION LICENSE BOND 100.00 <br /> AMOUNT DUE 100.00 <br /> Comments: <br /> Thank You! <br /> WE APPRECIATE YOUR BUSINESS <br />