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, `JEFFERSON COUNTY COLORA• <br />CLAIM VOUCHER RECEIVED <br />Date January 18. 1995 JqN 24 1995 <br />Claimant Division of Mineaals and Geology <br />Address 1313 Sherman Street, Roan 215 EIN or SS# <br />Denver, Co 80203 Divisio 0 ~N111ef ~ <br />flnantity I nascri nti nn I Unit <br />Permits for following 'Quarries: <br />M-80-084 Goltr'a Quarry $550.00 <br />bi-77-246 Green Valley Quarry 550.00 <br />M-77-245 Pine Junction Quarry 550.00 <br />br77-244 Dog Pound Mine 550.00 <br />lC7PAL <br />~~~~~ <br />$2,200.00 <br />BY: ~~l/1~1~ ~ ~il/1fi~~Gf~° DATE: / ~ 3-'98 <br />........................................................................... <br />CERTIF/CATIONOFCLAIMANT County of State of <br />I, the undersigned, certify that to the best of my knowledge and belief, the within account is true and <br />correct, and is now//due and,,((u~~npa/i/d./ <br />Claimant ~C4 ~u_ / ' /~ 1r'~n~,c o Date ~ o~ ~ <br />5EFORE PAYMENT CAN HE M DE THIS VOUC~R MUST BE S~GN~AND RETURNED TO: <br />JEFFERSON COUNTY ACCOUNTING DEPARTMENT <br />100 JEFFERSON COUNTY PARKWAY GOLDEN CO 80419-4560 <br /> <br /> <br />