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MINED L ~ RECLAMATION DIVISION N° ~-~ 0 8 5 3 0 <br />1313~Sherman, Room 423 <br />Denver, Colorado 50203 ~ DATE ~ a ~s .~ <br />(//3~~0((3~~) 866-3567rn \ <br />RECEIVED FROM _]]~J~1O i' 1 Dtr m~/Lf AI ~~di71n ~/(~) <br />THE SUM OF ~ v~ DOLLARS $ __'fL.SL•~ <br />(~ ~+ ( (~ ^ ras-i <br />FOR i'\(Y1//'1 7Q~ ~ - b~ - I ~~~ ~[7 7 pcK <br />AMOUNT OF ACCOUNT...... $ <br />AMOUNT PAID ................ $ <br />BALANCE DUE ............... $ <br />¢~~/~Najj////n~~~~~ ~oul <br />BY ~ \ ftFJ~~~ <br />