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MINEr 4ND RECLAMATION DIVISION <br />~ 313 Sherman, Rm. 315 <br />Denver, Colorado 80303 <br />(303) 866-3567 <br />RECENED <br />~_ ~< ' <br />AMOUNT OF `ACCOUNT ... ......$ <br />AMOUNT PAID ... ..............$ <br />BALANCE DUE ...... .......... .$ <br />BY <br />~'° 1542GG}}8~~' <br />DATE ~ ~ ~ ~ 19L~ <br />$~ <br />^ CASH <br />6-caiECi <br />^ M.O. <br />