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<br /> MINED L"'0 RECLAMATION DIVISION Air 19990 <br /> ly. Sherman, Rm. 215 _ <br />Denver, Colorado SG203 - , <br />DATE ~ ' 7 19 <br /> (303) 866-3567" <br /> RECEIVED ~n~ <br />~ <br /> FROM <br />~"~' • G <br /> a~ <br /> °~ ~ ~'~aOLLARS <br /> ASH <br />^ CC <br /> ~' C '7 ~,~g <br />H <br />// ( <br />FORS ~ DO //1- ~(1 '~/n L /U~YC7 MO.K <br /> it <br />AMOUNT OF AC UNT. ....... .$ <br />15t~I1~ Q~. <br /> AMOUM PAID .... .. .......... $ / <br /> BALANCE DUE ..... .... ........$ BY <br /> <br />