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~ iii iiiiiiiiii~iiiii <br /> <br />• <br />LOGAN COUNTY STERLING, COLORADO __.~ ~/ -. 19 9~ <br />n ~ !3{3 SH~'~*~I^'' S~ ~ ~2if <br />T01~/U~~~~~.~~~~7-~> (~G.[\! -_~R. ADDRESS-~d/Y~P_, ..~ ° _~'62~-- <br />Have all hills itemized, OK'd and acknowledged before filing with County Clerk. <br />Give number of State Road; also specify where work wee done. <br /> <br /> I eo>,,1,-t,~ ell ~-t _~ - - ;:°.- ~ a4 <br /> <br /> ~J VCS ~It'Y ~Z (~ /'1 ~~J ~~ 7 _ ~~ (-' /70 <br /> <br /> <br /> <br /> <br /> D <br />STATE OF COLORAD9L COUNTY OF LOGAN-se. <br />L....l.L_'Y._S-. ~1.-~-..._..-.--_--..-.--_..______.._.._._.__-_, do solemnly swear that the several ltema meatfoned Ia the <br />saaesed account are )uat and true, that the Artlclee were furalehed ay therela charged, and that the amount clslmed, to•wlt: <br />// ~Serelces were rendered <br />the sun o[.... .._.... _. _~._~f-J~ .-DOL~S, le du nd ua aid, after allowing all )uat credlta. <br />(81ga I;ere)~ `~ <br />Subscribed and sworn to before me thle.._..___...__._.day <br />Dartrrr <br />19_ <br />Clerk <br />------+~-ryvu-nave-any-questions;`"please contact this office as soon as possible. ~v <br />i'~_-~.~~~ ~ OCT 0 419.91 1 <br />~C ~ Mined Land b~ <br />ReclamatiorrfliJision <br />