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PLEASE DETACH BEFORE DEPOSITING CHECK <br /> DESCRIPT'-NjINVOICE NO. <br /> GROSS AM NT DEDUCTIONS NET AMOUNT <br /> DATL <br /> 350. 00 <br /> 4-8-86 Annual Fees <br /> APR 9 <br /> MINED NO <br /> CLAMATION DIVISION <br /> MINED LAND RECLAMATION DIVISION N ' 005660 <br /> 1313 Sff' tan Street Room 423 <br /> L..rver, CO 80203 <br /> (303) 866-3567 DATE -_ s J_L(� <br /> RECEIVED FROM A '� •a� ��\-p <br /> THE SUM OF V OLLARS $ l/ 00 <br /> C ECK <br /> FOR F�j� � :� <br /> AMOUNT OF ACCOUNT.. ....$ <br /> MQ t{2 OuI <br /> AMOUNT PAID... .............$ <br /> BALANCE DUE.. .............$ BY <br /> MINED LAN(, ECLAMATION DIVISION N _ 005665 <br /> 1313 Sherman Street Room 423 <br /> Denver, CO 80203 DATE AO Ct 19rd b <br /> (303) 866-3567 <br /> RECEIVED FROM <br /> THE SUM OF f` $ - -50 • oO <br /> ❑C. <br /> FOR yit MIS & � <br /> ❑.o. <br /> AMOUNT OF ACCOUNT. .....$ (•'YI ^�� /Foul <br /> AMOUNT PAID................$ <br /> BALANCE DUE...............$ BY <br />