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iii <br /> <br /> MINED LAND RECLAMATION DIV' ~N N~ 14150 <br /> 1313 Sherman, Rm. 215 <br /> Denver, Colorado 80703 DATE ~ "°~ t9 <br />(30 <br />3 <br />) 866-3567 <br /> / <br />~ ~~_y <br />/ <br />_ `_ ~ n <br />D G~/~"LGL'Q~ ~~t~k'1~-C~l/9 <br />.~1 <br />$ <br />ROM E ? <br />J~• L7 <br /> <br /> 11 <br />J <br />~ 1 <br />~ <br />~ <br />~ <br /> . <br />y~ o d <br />MP~ic o.r~ ~_[,/_~ ~- <br />~OP~~ DOLLAR <br /> / ^ CASH <br />g.L~ ~~ ~(tD7 O MOCK <br />FOR ~'.civ+--i> ;7 <br /> -r <br />~ <br /> AMOUNT DF ACCOUNT <br />...........$ (`'p1IA MM /`'~ <br />~ I1 i <br />~ <br />! <br /> ~ <br />AMOUNT PAID ............ ... ..$ V IIQII <br />KOu <br /> <br />... ............. <br />BALANCE DUE. $-T_ Y ' <br /> <br /> <br /> <br /> MINED LAND RECLAMATION DIVISION N ~ 14 3 5 7 <br /> 1313 Sherman, Rm. 715 (X~y <br />Denver, Colorado 80703 DATE <br />19 <br /> ~ <br />67 <br />(303) 866-35 <br /> n (~ $ <br />^ <br />RECEIVED ~^ _„ ~ A 1 ~ _ 117 _ I J <br />~ <br />3~~ <br /> ~ <br />~ <br />`1LLLLLL.AArSSS !1-C <br />(Y// ~(xL1 <br />F <br />RO <br />M <br /> ~ <br />_ <br />J L <br />c <br />~ <br />/L <br /> , I <br />1 11 Jl 0 ~ ~/n,~~ S ~! 1.(l V <br />S <br /> ^ <br />FORNDy ~-90.5 /h~S~y-31c+ ~~~3oMH H <br />CK <br /> AMOUNT OF ACCOUM..... .. ..$ ~ Q~(_ DU~ <br />~~11 1 <br /> AMOUNT PAID ... .......... ....$ ~.t <br /> BALANCE DUE ..... .. ....... .$ BY <br /> <br /> <br />