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f : ~ ~ III IIIIIIIIIIIIIIII <br />i MiNED LAND RECLAMATION DIVISION N 0 O O 7 O 3 H <br />1313 Sherman, Room 423 <br />Denver, Colorado 80203 PATE 1C1 :~ ~s~_~ <br />(303) 866-3567 ' <br />/~ \ 1 1 , <br />' RECEIVED FROM C~1(` ~'(n ` ~ `-~ J1~LC~.~..\ , <br />THE SUM OF n-i'~ry ~~~~~ J~OLLARS $ ~~~~ ~)~~ <br />] cns. ~ <br />FoR (~'~ n ~ F ~~ Yl'1 - G7 - '• C ~ ) L G ~-] I 'J ~~K <br />AMOUNT OF ACCOUNT...... $ <br />AMOUNT PAID ................ $ <br />~~Qn~ ~Ou~ <br />~ ~ BALANCE DUE ............... $ BY ~ ' \'~w ~ ~~.. ~ X+1 ~,n. - .' <br />COLORADO IEN COMPANY _. •,-. <br />C~I-IF=CIA I~IO. r 13 <br />II„~ Im.l i:HECF~ CIf~TE:- .LU/20iL97 <br />fllf l' r nLLI\~ .'n LUItA Un MU:Y!_ <br />~~~ ~ ~~ <br />'MT 9/30 00967f~ F'EkN1I'f ~lO, i~f-77-302 ~ ~~.UO <br />''MT 9/3 009677 F'EkPiIT P!O. ~f-77-301 _~~,~~,3SO.OO <br />~G~ ~ ~9~1 700.OO <br />~G~~F`J ~ ~~y\~40~ <br />yENLtiilfi 219U~?L1 <br />350.00 <br />350.00 <br />700.00 <br />DETACH BEFOPf ^'DOSITING <br />