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<br /> MINED LAND RECLAMA710N DIVISI N p Q 6 7 4 <br />' 1313 Sherman Street Room 423 <br /> Denver, CO 80103 <br />(3 3) 866-3567 DATE 19 ~/ <br /> RECEIVED FRO S <br /> ~ <br /> THE SUM OF <br />OLLARS $ t~t1,1L ~ ~% <br /> ^ cAS. <br />S ~+ECK <br /> FOR _ <br />^MO <br /> <br /> AMOUNT OF ACCO NT...... $ ~~ <br />~ ~O <br />` <br />I <br />~ <br /> Il <br />AMOUNT PAID ................ $ <br />~ <br />f, <br /> BALANCE OUE .. ............. $ BY <br /> <br />