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<br /> MIN LAND RECLAMATION DIVISION :J~ 15444 <br />~- 1313 Sherman, Rm. 215 <br /> Denver, Colorado 80203 1~/_ ~ ~ 19 q i <br />(303) 566;3567 DATE __[L_ <br /> (~-~ $ <br />RECEIVED ``^/--~~~ <br />', <br /> ~ <br />, <br />, <br />FROM x.13 )~l 1' l.fAli.v'~A <br /> <br /> ~- <br />~ <br /> ~ <br />,~ <br />M ~~^^~~ < ^ CASH <br />FOR <br /> <br /> AMOUNT OF A OUNT ...... ...$ '^ <br /> AMOUNT PAID ........ ... ......$ ~'t <br /> BALANCE DUE .. ... ...... .....$ BY <br /> <br />