Laserfiche WebLink
III IIIIIIIIIIIIIiiI <br />999 <br /> <br /> MINEL _,AND RECL4MATION DIVISION I~C 19614 <br />1313 Sherman, Rm. 715 <br />Denver, Colorado 80703 DATE S- /.~7 ~9~Z <br /> I <br />C/ <br />EO ~IAO r <br />C LPG <br />n <br />n <br />~L/P'ln ~ /J <br />RO <br /> , <br />. <br />. <br />. <br />, <br />~ <br />F <br />M <br />~) ~ <br /> / /~j Q / _ ^ CASH <br />FORQ/~~~. PFl' /~/~ /U" III v?/.~~ ^MOCK <br /> <br /> i <br />AMOUNT OF UNT ..........$ <br />1 <br />a <br />! <br />~ <br /> , <br />OU <br />/1 <br />AMOUNT PAID ......... .... ..$ / <br />o <br /> y <br />/ <br />Jn <br />~/t~ <br />BALANCE DUE .. ................$ BY <br /> <br />