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MINED LAND RECLAMATION DIVISION N~ 14608 <br /> 1313 Sherman, Rm. 215 <br /> Denver, Colorado 80203 DATE ~ ~ y 19~ <br /> (303) 866-3567 <br /> RECEIVED {~ ~ (y` $ <br /> <br /> <br /> <br /> <br /> ^ CASH <br />FOR C~ni/~ Q /1'1 _ sn • l 3 1 ~ y~3 3 DC3-CAL-IpCK <br /> <br /> AMOUNT OF A UNT..... .....$ ` IlQrlul <br />UI'l lA <br /> AMOUNT PAID ... ..... ...... ..$ <br /> H4IANCE DUE ..... ............ $ BY <br />