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<br /> MINE. AND RECLAMATION DIVISION ~ <br />_ O O 6 O 5 O <br /> ,_ <br />1313 Sherman, Room 423 •. <br />Denver, Colorado 80203 ,, DATE ~s ~ 7 <br /> (303) 866-3567 <br /> RECEIVED FROM <br /> <br />d Q~ <br />~') <br />3S0 <br /> • `~ ~/ <br />OLLARS $ <br />THE SUM OF <br /> CK <br />' <br />S- <br />- <br />~ <br />~ <br />~ <br /> o MO <br />O <br />1 <br />7 <br />. <br />~iX <br />FOR '~71/Y\ YCY <br /> <br /> AMOUNT OF ACCOUNT...... $ <br />A <br />~u <br />Q <br />~ _ <br />` <br />l <br /> (~J I1 <br />11 <br />N <br />l <br />~~` <br />../// <br />AMOUNT PAID ................ $ ~U11 <br /> BALANCE DUE ............... $ BY ~ <br /> <br />