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MINED I 'D RECLAMATION DIVISION 19814 <br /> 1-3 Sherman, Rm. 215 � / C cy <br /> Denver, Colorado 80203 DATE�192- <br /> (303) 866_35 7 <br /> RECEIVED JX Io�O .c�1J <br /> FROM <br /> ��i/Lp �33A�C1C�lJclllf.��iL'lilYl --"OO[LARS <br /> q ID CASH <br /> FOR SC^n E/ U C� I 1 p M EC <br /> AMOUNT OF A COUNT. ....... .$ <br /> ft <br /> OU. <br /> AMOUNT PAID .......... .......$ <br /> BALANCE DUE..... .. .........$ BY _ <br />