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REP25504
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REP25504
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Entry Properties
Last modified
8/24/2016 11:57:04 PM
Creation date
11/27/2007 4:14:47 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1981250
IBM Index Class Name
Report
Doc Date
6/30/2003
Doc Name
Annual Fee Payment/Report
Permit Index Doc Type
Annual Fee / Report
Media Type
D
Archive
No
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CLAIM VOUCHER <br />Submitted by: <br />Yuma County Road & Bridge <br />1310 S Blake <br />Wray, CO 80758 <br />Date: 05/19/2003 <br />RECEIVED <br />1UN 3 0 2003 <br />Division ~f Minerals and Geology <br />Reference: Permit Fees <br />Order/Req : 050-053003 <br />Dept: <br />Date: 05/30/2003 <br />Pay TO: Div of Minerals & Geology <br />1313 Sherman St Rm 215 <br />Denver, CO 80203 <br />QUANTITIES Stock/ Unit Date <br />Ordered Recd Item No. Description Price Invoice Recd Account Total <br />1.000 1.000 M-1981-250 annual fee Brand 688 .0000 M-1981-250 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1981-254 annual fee Collette 281 .0000 M-1981-254 05/12/2003 02-704-6455 281. 00 <br />1.000 1.000 M-1981-256 annual fee Ekberg 688 .0000 M-1981-256 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1981-258 annual fee Fadenrecht 281 .0000 M-1981-258 05/12/2003 02-704-6455 281. 00 <br />1.000 1.000 M-1981-260 annual fee Gelvin 281. 0000 M-1981-260 05/12/2003 02-704-6455 281. 00 <br />1.000 1.000 M-1981-176 annual fee Groves 688. 0000 M-1981-176 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1983-061 annual fee Kurtzer 688. 0000 M-1983-061 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1981-178 annual fee May 688. 0000 M-1981-178 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1981-179 annual fee Mekelburg 688. 0000 M-1981-179 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1981-263 annual fee Mullins 686. 0000 M-1981-263 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1989-038 annual fee Oestman 688. 0000 M-1989-038 05/12/2003 02-704-6455 688. 00 <br />1.000 1.000 M-1981-267 annual fee Soehner 281. 0000 M-1981-267 05/12/2003 02-704-6455 281. 00 <br />Total: ss2a.oo <br />I DO HEREBY CERTIFY this claim voucher is a true and accurate accotinting of goods and/or services received <br />pursuant to the referenced purchase order. <br />AUTHORIZED SIGNATURE: <br />
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