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• <br />C~ <br /> <br /> MINED `ND RECLAMATION DIVISION„ ~ ~ 15092 <br /> y~ l3 Sherman, Rm. 215 ~' <br />Denver, Colorado 50203 <br />DATE Z ~ 7 19 "/' / <br /> _ <br />(303) 866-3567 <br /> $ <br />RECEIVED {/,~ n <br />~ <br />~ <br /> . -~SO. <br />XF6 +YI ~f7X~d <br />FROM <br /> eYJ <br /> DOLLARS <br /> °~s• ^ CASH <br /> ~~ ~~ `o-M OCK <br /> FOR - <br /> <br /> AMOUNT OF ACCOUNT. ...... ....$ I^ 'AI^ 1' <br />~ <br />! <br /> AMOUNT PAID ........ .... .......$ 1lQYl YL <br />ou <br /> BALANCE DUE . ....... ....... ....$ BY <br /> <br />