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i <br /> MINED LAND RECLAMATION DIVISIO 1 N 011311 <br /> 1313 Sherman, Room 215 <br /> Denver, Colorado S0203 DATE �� Z y 19RECEWED b 1 <br /> (303) 866-3567 <br /> FROM f.1 a)Y1.7 LJ I�SY\ <br /> �L `� Z DOLLARS <br /> U ' / ^� ❑ CASH <br /> FOR II/✓l/r\ �QD //^ !7— T,e t 7 .��I S��p 1` o K <br /> y� <br /> AMOUNT OF ACCOUNT...........$ /� ' I <br /> AMOUNT O,' <br /> PAID................. .$ J rl �•\lf� U <br /> BALANCE DUE...................$ BY <br />