REP00034 ‎(3)‎

MINED LkND RECLAMATION DIV N N0 008756
19 13 Sherman, Room 423
Denver, Colorado 80203 DATE '
1J(33/03}J866-3567
RECEIVED FROG -_f 0 au -
THE SUM OF_ LLARS $ ��^� CQ
FOR S1� S M �2- ate/ -d O� -fl(fi � �7r�ln�nnocK
AMOUNT OF ACCOUNT......$
ante ouf
AMOUNT PAID................IS
BALANCE OUF:...............$