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iii iiiiiiiiiiiiiiii <br /> <br /> MINED LAND ~CLAMATION DIVISION N 0 2 2 ~ ~ 9 <br />1313 ..erman, Rm. 215 Q <br />Denver, Colorado 80203 DATE ~ ~' 19 / <br /> (303) 866-356; <br />RECEIVED ~ ,~ . ,`yn~-- < ~ f\ <br />~~ <br /> J~ ~J <br />FROM 1jL l .a ~,~U' <br /> <br /> DOLLARS <br /> O CASH <br />-~6FIECK <br />~ <br /> FO <br />O M.O. <br /> <br /> AMOUNT OF OUNT....... ...$ I <br /> AMOUNT PAID .............. ... $ <br /> BALANCE DUE .............. ... $ BY <br /> <br />