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P A Y E E DETACH THIS ST ATEMENI BEFORE DEPOSITING CHECK KYBATO INCORPORATED <br /> DATE ACCOUNT OR \' DESCRIPTION AMOUNT DISCOUNT OR NET AMOUNT <br /> INVOICE NO I I DEDUCTION <br /> 8-19-85 Last Chance Mine-File# M-77-468 $50.00 <br /> EMPLOYEE'S <br /> NAME <br /> PAY PERIOD GROSS NET <br /> HOURS RATE EARNINGS <br /> ENDING EARNINGS FICA FED WITH STATE WITH TAX TAX PAID <br /> REG. <br /> D T o [N] <br /> EMPLOYEE. THIS IS A STATEMENT OF YOUR EARNINGS AND DEDUCTIONS FOR PERIOD INDICATED KEEP THIS FOR YOUR PERMANENT RECORD <br /> MINED LAND RECLAMATION DIVISI N 004854 <br /> 1313 Sherman Street Room 423 <br /> Denver, CO $0203 [DATE C" 19- 19 �S <br /> RECEIVED FROM <br /> (303) 8660 ^(//�-3567 v Me <br /> THE SUM OF -4- 1 OOLLARS $ <br /> [� ❑ <br /> I (7 cns+ <br /> FOR IT M/V\ �n0 �lDd ocK <br /> .14AMOUNT OF ACCOUNT......$ 9 k CI ou! <br /> AMOUNT RAID................$ <br /> BALANCE OUE......... ......$ BY <br />