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III IIIIIIIIIIIII III <br /> <br /> MINED LAND RECL4MATION DIVISION N~ 19823 <br />1313 Sherman, Rm. 215 <br />Denver, Colorado 80203 / <br />(303) 886-3567 DATE VJ " /~ t9 <br />RECEIVE _j~ $ <br />FROM ~~.i~ ~~. <br /> D l - ~ ~ .~> z ' ~ ~~ <br /> <br /> /~ ^ CASH <br /> <br /> AMOUNT OF ACCOUNT..... .....$ ~ o,ll <br /> AMDUNT PAID .......... .......$ IA <br /> BALANCE DUE . ......... .... ....$ BY <br /> <br />