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III IIIIIIIIIIIIIIII <br />MINED I D RECLAMA710N DIVISION <br />~:rr3 Sherman, Rm. 215 <br />Denver, Colora~?a_80203 _ <br />_ (303) Sk6-3567 <br />-x~- <br />AMOUNT OF MCCOUNT...... ... $ <br />AMOUNT PAID ....... ...........$ <br />BALANCE DUE ...... ............$ <br />n' 15175 <br />DATE rY ~ ...7 ? 19~ <br />$~c~~ Sd1J <br />_ DOLLARS <br />^ CASH <br />$Ct~ECK <br />_ ^ M.O. <br />Q ~ OUr <br />BV <br />