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<br /> MINED ' 1ND RECLAMATION DIVISION p <br />~S 13 Sherman, Rm. 215 ~,.1 _ 16 4 51 <br /> Denver, Colorado 80203 DATE 7.3/ t 9_pL_ <br />(303) 866-3567 $ <br />RECEIVED n ~~,~ n ~~O Q~ <br />FRO <br />M <br />~ <br /> <br /> ~/ <br />// <br />C/yl1C_ ..~.C1~22C <br />/IU~ciir~~id- d~OtT---DOLLARS <br />l <br />~ <br />G C <br />~' <br /> <br /> ~ <br />y <br />7 <br />l <br />V <br />FOR~~7//-aCO '~D~ // t3n~~{pK <br /> <br /> AMOUNT OF ACCOUNT ...... ...$ <br />~ <br />~ <br />~ <br />I <br /> AMOUNT PAID ... ...... ... ..$ <br />ur~ <br />ou <br />~J <br />~ ' <br /> ~y <br />/ <br />BALANCE DUE . ......... .... ..$ BY~L ~G!!/Yl9Al~C~ <br /> <br />