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CGLOkADO ©UARD OF LAND COMM1.551'CtJEY.S <br />52C Centennial Building, 113 Sherman Strc-et <br />Uenunr, CG 60X3, (303) 666-3757 <br />t~iNERAL RO1'RL7Y REPORT <br />Lease Tape L? CM ~ GP q? L'ft C}' PL r,E GS Ott OS Ohl (CIRCLc ONcj <br />State lc~a;e rv'o rg~_395 Original R r;djusCruent <br />County,_Cg~ojc,s _.__ Production ,~~enth u Year ~C,i~'1~1 ~r;lCr~- <br />tessee Produced and/er Operal•ed Cy , <br />Svbsect:on_~SrQTR SecCion;s)_~4 Tocrnshi.p_____~~_~~ian9o_~~ <br />P,^'oduc,C _ Pi L' Run . <br />Unit of rica,ure Yp 'iM l.B O'L Ot OT (CIRCLE OcdE) <br />Qeginni ny Inventory Units Produced ls~ _ <br />Endiny l;,vuntury L'•nits Sold <br />Sellsng ?rice Per Un`t Gress Sales _ <br />Royally Ratc_ .30_ koYAt7'r Du[ J;3,,~'.OZJ' _ <br />For AJj ucCzd .ke~arta, Previous Amount Paic. <br />Advance ;:ini;;n:m ltoya]Cy credit (if applicable) <br /> RCYFlf.TY nAID __ 1 ~3S~o ~~ _ <br />If t:~is 'z; an an adjG,l;rcnt, pl ease r.xplain_ <br />Contact'::ame____~hi1 ,Ie.~st_- Telephone rro.___jto-;,g.~_j~6,2 <br />I certify that this i.s a true and correcC stalen'~ent of production sold, uaiue <br />received, and rolally cue the State cf Cclu.rado for the period indicatecS. <br />~ r <br />Author.ced oignature G Title <br />i cpurti n~ Corn, any Na;r, ~, Alamosa County Road & Bridge 'N U,nber <br />Flddre:ss 8663 S. County Road 109 <br />Alamosa. CO 81101-9423 <br />Subscribes ant ;worn lu before me by <br />vr. This day of <br />i',y 'Ccn;nission Expires <br />Notary. ?ublic _ <br />Date' Stam,c <br />Land L•oard Use Unit' <br />Verified <br />Po•ted <br />Notes <br />:9 <br />S9 -- <br />eceicc No. <br />Da <br />