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iii iiniiiiniinii <br />999 <br /> <br /> MINED LA RECIAMATION DIVISION N 19965 <br /> 131 Sherman, Rm.. 5 <br /> _ <br />Denver, Colorado 80203 ' <br />DATE 1 ~ ~' 19 f/ <br /> (303) 866-3567 <br /> $ <br />RECEIVED I, <br />/ <br />~ <br />' <br />~ <br />~ <br /> ( <br />FROM ~`_. / <br />'~: <br />~l 71 `I~.~ <br />r~~~d~.i. <br />! . ~ <br /> / <br />( <br />T <br />~~ <br /> ~ `,t <br />~% r' z: ~ ~ ccr, LI- LL.Y .~l~, <br />- _ _o-OCLARs <br /> ^ CASH <br /> ~ (J E3-CHECK <br />~ - <br />~ <br /> FOR <br />~ <br />^ M.O. <br /> <br /> AMOUNT OF A OUNT... .. ....$ ^I^'^ <br />~~ MIIK ~ O~I <br /> AMOUNT PAID .... .. ....... .. $ <br /> ~ <br />'~ <br />~ <br /> BALANCE DUE . .... .. ...... ..$ BY <br />- <br />- <br />, <br /> <br />