Laserfiche WebLink
111 I1l111111111!!11 <br /> <br /> MINED V 'RECLAMATION DIVISION -. N ~ 21600 <br /> 13'n Sherman, Rm. 215 <br /> ~~~ ,~ [(// ~~77 , <br />Denver, Colorado 80203 DATE ~9s~ <br /> ( <br />3 <br />03) <br />866-3567 <br /> I/~~\ <br />( <br />1 <br />(1 n (1 $ <br />( <br />( <br />u <br />~~ Ifi <br />~~CO~L <br />~! <br />V~ <br />~ <br />C, orY,U .r 7D. L <br />F <br />OM <br />~ <br />D <br />! <br /> R <br />1 <br />,// / <br />~ <br />(l~I <br />J <br />~ <br /> ~ <br />, <br />Y-(/ 12/1 I { <br />, <br />/ <br />/ <br />~ <br />- <br />l l L~'Ll.r/~lQ.{X /71liYL~_ / tY <br />j LAPS <br /> <br /> ^ CASH <br />/~ (, H-CHECK <br />~J~ <br />~ <br />~ <br /> FOR SY//SC~ { <br />l - <br />J1 - ~ <br />~ 703 ^ M <br />O <br /> . <br />. <br /> AMOUNT OF ACCOUM...... .....$ <br />!n ~ 0!, <br />•~ lA <br /> ~ <br />AMOUNT PAID ... ............ ..$ <br /> BAIANCE DUE ...... ... ... ... $ BY <br /> <br /> <br /> DI~,ON OF MINERALS AND GEOLOGY ~ N ° 2 6 0 4~9~ <br />_ ._ DATE /~ 19_~.G <br />RECENED $ <br />FROM <br /> ~RS <br /> //~~,~,,,, __~ ^ CASH <br />FORw~I~y ~ ~ a39i~-~DK <br /> AMOUNT OF CCDUNT...........$ '^ <br />Q!l l~ . <br />AMOUNT PAID .............. ....$ <br />BALANCE DUE ...................$ BY <br />~ I <br /> <br /> <br />