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MIND LAND RECLAMATION DIVi,.aN <br />1313 Sherman, Room 423 <br />Denver, Colorado 80203 <br />RECEIVED FROM <br />THE SUM OF <br />FOR <br />AMOUNT OF .ACCOUNT...... $ <br />AMOUNT PAID ................ $ <br />NrS°_ 0'0 9 019 <br />DATE ~.L~ ~9 <br />i <br />CAS~i <br />HECK <br />^ rn.o <br />BALANCE DUE ............... $ BY <br />