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iii oii~uiioi~i~iiiii <br />999 <br />MINED LAND RECLAMATION DIVISIC'' <br />1313 •Slterman Street Ruom 423 <br />Denver, CO 8003 <br />RECEIVED <br />THE <br />/ /~ <br />!V~ 2621. / <br />~~J}.~-- <br />^// ns~ <br />/ ~ / '[71 ~~y.HECK <br />_~,~i--- C~ M O <br />AMOUN'i OF A[;CC]UNT...... $ <br />AMOUN i PAID... ...... $ ~~~~~/ / , <br />