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"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc.,
P. shown on this document. I also represent that I have
• personal measured the distances set forth on the diagram."
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RECEIVED 3.0k.
® SlGNAT R DATE
JUN 10Z003
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TOVYN It��R�lD CODEY RECEIVED
BUILD
JUN 1 0 2003
TOWN OF QUEENSS RV
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