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<br />MINED LAND RECLAMATION DIkISION N 0 0 0 8 5 9 2 <br />1313 Sherman ' <br />Denier. Colorado 80]03 DATE _~_~-- i s~ <br />' +/ (303) 866-3567n /1 ~q $ <br />OM O~"'~~~Qi/Yl ~,1~~~ CoTxi ll. l11.1~i.rn e.C.C./.~ <br />~~3~- <br />AMOUNT OF ACCOONT...........$ <br />AMOUNT PAIO ...................$ <br />BALANCE DUE ...................$ <br />DouaRs <br />a o q o CABH <br />'CHECK <br />~Q4a~ ^M.O. <br />~a ~ ~~ <br />BY <br />~ w « <br /> ~ ~ _ <br />o ~ o <br /> ° ~ "d <br />m <br /> <br />n ~L <br />no <br />= q <br />n <br />. r <br /> <br />9 <br />~ <br />~ O 9 w <br />v ¢ <br />m w ~ <br /> <br />? <br />u ;E e > ~ U nJ ~v <br />° <br />c 4o <br />i O iG ~ <br />r <br />L = v= <br />{> <br />V <br />~ e W <br />~ v~ <br />Q <br /> <br />'" ~ <br />Fe U <br />= «g <br />; <br />~ .. <br />u~ <br />~ N <br />c0 a <br />vo <br /> <br /> <br />`e LL> _~~ <br />; o ~ <br />o c. n ~. u <br />v a <br /> Q n m Q <br />u ~ f o - pp ; <br />` <br />> <br />° a'.p <br />L O H ^ CQ ^ a <br />O to <br /> <br />• ° <br />"Vi <br /> <br /> <br />° V~ <br />f S-a <br />c <br />r ~ i! o <br /> !_ <br />e_. <br /> <br />° cam <br />° ro= <br />e <br />C V O. ~ \~} <br />m <br />t e 09L <br />°oe <br />N \ <br />lV e <br />~ LLf C <br /> <br />a <br />F- °~" ~ <br /> j~a /,b <br /> z <br />>> <br />a <br />r <br />E ~ <br />. <br />~;m~aV <br />y Oa <br />wo <br />,°. <br />- rm <br />¢ m°~ <br />a ci w <br />~ e V <br />W <br />P <br />` O <br />: 9O~ <br />O d <br />w <br />v Y c <br />a L''0 <br />E <br />o <br />O ~: <br />o <br />II ra e; <br />oc m m <br /> <br />~ <br /> <br />~ <br />((Q~~~ <br />~ v` <br />a <br />Q c <br />a, <br />Q T <br /> <br />~ LO <br /> <br />a D <br />m F« <br />° v <br />v ~ I I <br />~ <br />w a <br />3 <br />of Yo <br />~ Q 3' <br />~ ~_ m <br />« m O <br />~ <br />2p o: o v ~ m m c <br />Ne ~piE^ C <br />Q Gi crn_ <br />N o_ <br />• <br /> ~ ~ <br />G' M Iq X fD X <br />F- <br />6 <br /> <br />W <br />U <br />W ,.~/~ <br /> <br />~ r' <br />~ISJ I r l - O°~ 'bu/ <br />Z P 765 476 281 ~ <br />Q <br />~ <br />RECEIPT FOR CERTIFIED MAIL E <br />~..~ <br />W NO INSURANCE COVERAGE RROVIOEO <br />R NOT FOR INTERNATIONAL MAIL 4~ <br />W <br />~ (See Reverse) ~1 <br />~ - i.J <br />W Sn~ O r L7 <br />o =T <br />O Street at{tl No. _~ p, W <br />antl <br /> Postage _ ~, .lJ <br /> i r <br />L <br />d Cede ~~, l=a ~ _' cr' <br /> <br />u ~ SDenal Deliver Fe n 1~~ <br />I /L <br /> J J <br />O <br />1 A <br />Reslncleo Delnery Fee <br /> <br />G . <br /> <br />R <br />eium ~~iD~i I°~~ ~1 <br /> <br />11`J!h11 <br /> ,~ <br />~ o <br />ReNrn Receipt showmq ro wham, <br />r <br />- <br /> y <br />Date. antl Atltlress of Deuve <br /> ~ <br />TOTAL Postage and Fees 5 <br />e- ~ <br />~ <br />~ <br />W <br />~ <br />~ <br />Postmark or Date <br />~ ~+ ~ <br />~ E <br />~ LL <br />~ N <br />tai n _ -.. - ~ ~`- <br />` <br />o <br />y <br />6 <br />