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<br /> <br /> MINEf AND RECLAMATION DIVISION iJ~ 23034 <br />1313 Sherman, Rm. 215 - Q <br />Denver, Colorado 80203 DATE J~• ~ 19 ( 3 <br /> 303) 866-3567 $ <br />RECENED P //'~,~~ ~ p <br />~ <br /> FROM Y Q /~_ ~-!J ~ l..L <br />/V . <br /> <br /> '\ y`/t lYl GY. ~n A/ in Pm Ai V" //1---DBCb1RS <br /> <br /> ^ CABH <br />CC c $.~,~ECK <br />FOR ~-` Q(] ~ ~J~~ ~ .~J~nC ^ M.TI. <br /> <br /> AMOUNT OF COUNT .. .......$ '^ ~ /~' <br />l <br />A <br />` <br /> <br />/ <br />` <br />u <br />AMOUNT PAID ...... ..... ..... $ Il ~ <br /> BALANCE DUE . ......... ... ..$ BY <br /> <br /> <br />