REP00013 ‎(2)‎

MINED LAND RECLAMATION DIVISION N� 009838
1313 Sherman 3,/// Denver, Colorado 80203 DATE 19 El
RECEIVED (303) 8663 7
$ `n
FROM
00 LLARS
/ D CASH
FOR QAvr� a p0 /yl - Asa -'�D7 -2137 0 M.O. K
AMOUNT OF ACC UNT...........$ k9 V1I2 OUf
AMOUNT PAID ...................$
BALANCE DUE ........ .........$ BY Q