REP29572

• Permit No: M1977193
• IBM Index Class Name: Report
• Doc Date: 11/1/1983
• Doc Name: 112 ANNUAL FEE LETTER
• Media Type: D
• Archive: No

PS Form 3800, Feb. 1982

L r U.S.G. P.O, [884448-0 14

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.SENDER: Complete items 1 end 2 when atlditlonal wrvfcla.ars dwirad, end complete (tams 3
entl 4.
Isrt Your address In the "RETURN TO" Space on tha ravsrsa side. Fellure to tlo thls will prevent this
4wd from baing returnatl to you. TM return rss:alpt fw will provide vau the name of tM oarwn
vyad to and the Bete of dallvarv. For additional faw tM following wrvkw an avNlabN. Conwlt
~stmwwr for law and check box wl for additional wrvleatd rwuwad.
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M. Type ofrft~vice: ~
~/ ^ Registered ^ Insured
~7I ~~fy-~'Certifi~ ^ COD 'y~~
'LJ Express Meil
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C LvYL,©7`1 ~-C~{~ ~: ' ~ ~ 2 ~ ~__ Always obtain signature of addrYNe
Y ~ or agent end DATE DELIVERED. I
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tP.O. taortra•r4 DOMEiTIC 11ETUIIN IIECEI-T
MINED LAND RECLAMATION DIVISION N O 0 7 5 3
1313 Sherman Street Room 473
Denver, CO 80703
[phone] DarE 2 5 fe ~ ?
RECEIVED FROM -t~"~ v< ! ~-.
7HE SUM OF ~l• ~r' rt~`,V~ {K~F)
/ J DOLLARS $ 3-`1' DO
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FOR (' +) ~ -J-7 - I`i Z ~•//S ~"E`'
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AMOUNT OF ACCOUNT...... $
AMOUNT PAID ................$ ~l7QhI¢ VIQuI
L BALANCE DUE ..... ......... $ BY 1 ' v- .. a+ V