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MINED _ .ND RECLAMATION DIVISION ~_ O Q 8 8 9 O <br />1313 Sherman, Room 413 <br />Denver, Colorado 80103 pgTE ~ _~_ ~s~ <br />rants sea.ase~ <br />RECEIVED FROM ~~~ ~ /'~ <br />THE SUM OF '~ DOLLARS $ ~L/. Dc~ <br />^ ccs. <br />'/J~ ~ / ~iECK <br />FOR _P-~~_- - ~ - ~F o~ ^i.+.o. <br />AMOUNT OF ACCOUf`lT...... $ ~r ~~r_ n rol' <br />AMOUM PAID ................ $ n y~~J ``' JA IA <br />BALANCE DUE ............... $ BY ~~~.t~~'L <br />