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<br /> MINED LAND LAMATION DIVISION N O O <br />5 (~ Q <br /> ~ <br />1313 Sherman, Room 423 <br />Denver, Colorado 80203 DATE ~' ~ (] is ~ 7 <br />03) 8~66~-35A67~ ~ ` q 'nd <br />RECEIVED FROM. ~ O~ <br /> /~ <br />////~~~~..~~,, <br /> / <br />/ <br />THE SUM OF ~~ G DOLLARS $ ~ ~/ <br />~P u //~~ 11 p~ ^ cns.~ <br />FOR //1 ~ ~or "S O ~fS .~J~~j~pCK <br /> <br /> AMOUNT OF ACCDUfVT...... $ <br />~~q~ ~ <br /> <br />K/ ~-`I /A <br />Qul <br />J <br />~," <br />AMOUNT PAID ................ $ U <br /> ~ <br />~ <br />BALANCE DUE ............... $ BY ' ' W ~ <br /> <br />