REP00026 ‎(3)‎

MINED LA RECLAMATION DIVISION NO 007769
FF nver413 Sherman 00 19�
Denver Colorado 80]03, DATE
(303)'866-3567 $
RECEIVED
FROM
P U ,❑iCCASH
FOR Clfi flOO (p M.O.K
AMOUNT OF ACCO ...........$
TOO
AMOUNT PAID...................$
BALANCE DUE.. ..... BY