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r iT u ~ ~- .. . - ~ - ,ter ~~/~~. . <br />CGLOkADO BURRO OF LAND COt1M7.SSI0NCkS <br />52G Centennial Building, 1~,1'_ Shermin Street <br />Uenurr, CG 60X3, (303) 666-32A7 <br />;~INERRL RO1'AL7Y kEPOR7 <br />Lease: Type L? G~~S CL . GP qR u'R C1' PL GE GS D~' OS OM (CIRCLE ONEj <br />Stare l.~ase No. eP3395 Original ~~djustwent~_ <br />County__~os _ Production ilenlh & Year lel •/oZ00'Z. <br />Lessec_ Producetl and/or Operated By , <br />SubsectAon_'SSQTR Sec tiOn(5)^_4 Tpwnshi.p~(Z~_~Rangtt_ .. R <br />Pr'oduc,t _ Pi.t Run <br />Unit of tr~casure YO M l.B OZ BL OT (CIRCLE- OrJE) <br />Beginni n, Inventcry Units Produced ~~~ .OCj _ <br />Endiny Inventory Units Sold <br />sel]iny Price Per Unit Gress sales <br /> <br />Royilty <br />(fate .30 <br />RDYALTY DUE _ <br />~aL/~5~~ <br />For t,dj usted.Reports_ Previous Amount ?aid. <br />2dvar,cc Minimum Hcya;ty Credit (if applicable) ~ ~//,j Od <br /> ft C'f R t. T Y P R I D '; _~'~/ `'^f~J_ ~ a_ C% <br />~ <br />If this 'is ^n an adj~strr;cnt, p lease explain ~u~(.l~Zu~~ l<" r!~t~u"v`-=~ lUC~ <br /> <br /> <br />Contact'Narne ph;1 feat- Telephone No._ 71g_SR,Q._h?fi2;_, _ <br />I certify L•hat this is a true and correct statement o` production sold, ua]ue <br />received, and royalty cue the State. cf Cclgrado ('o.^ the period indicated. <br /> <br />AGthorized Signature G Title <br />Re pox ti no Company Nairn: ATSmosa. County Road & Bri ~e 'Number ~ Q ~ , <br />Rddress 8663 S. Countv Rd'109 _ <br />Alamosa, CO 81101-9423 <br />Subscribed 4n.c sworn '.o before me by <br />on rni: 1~ day of <br />FiY Conrnission Ex ices <br />' NC:drY Pub:ic~,~/jY <br />Date'Stamp Land L•oard Use Only <br />lJ/~ V~~ <br />1~ c~0~3 <br />Verified Receipt No. <br />Posted Da <br />Notes <br />