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.~ . <br /> <br /> MINED LAND RECLAMATION DIVISION N p ~ 1 ~ 8 9 3 <br />1313 Sherman, Room 215 <br /> p <br />Denver, Colorado 80]03 DATE O-~ i9~cL <br />(303) 866-3567 <br />ED <br />n $~ <br /> D <br />X ff A i ~„ <br />FRDM <br /> <br /> ~ / GU <br />~ <br /> /~1_„ ._ o ~ ~. L, ~n~! e ~ <br />--1 ~il+ ~/!'~i~_~~ DOLLARS <br /> <br /> ^ CASH <br /> 2(JCo U ~7G.~ ^ MOCK <br />FOR ~1tyLny_~ _~- 7g- <br /> ~ <br />~ <br /> AMOUNT OF ACCOUNT <br />...........$ /`'y, ~t'~nn'^ <br />~ <br />I <br /> QIIIL ~U <br />AMOUNT PAID ...................$ <br />~V <br /> C <br />BALANCE DUE .................. .$ BV/l!. / ~!tis~ ~~~,._ <br /> <br />