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III Illtlllllllll III <br /> <br /> MINED LAND RECLAMATION DIYISION N O 2 7 6 <br />o <br /> 1313 Sherman, Room 423 ~~~- <br />o ~ ~ -7 <br />Denver, Colorado 80203 DATE is <br />(303) 866-3 <br />67 <br />5 <br />~ <br /> (~ <br />( <br />RECEIVED FFIOM <br />~ /n'l_L_1~ 1 /I <br />V <br />~ <br />~~~~ <br /> , <br />(j~~ <br />~~ ~~ JJ//~~ <br />~^( <br />5 <br />THE SUM OF~ `~/ 7 <br />~OLLARS $ _ Li ~~/ - ~~ <br /> ^cn s+ <br /> ECK <br />FOR rnn. <br /> <br /> AMOUNT OF ACCOUNT...... $ <br />Hanle ou i <br /> AMOUNT PAID ................ $ / /~ / <br /> ~ <br /> ~ <br />BALANCE DUE ............... $ BY <br /> <br />