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DIVISION OF MINERALS AND GEOLOGY NO /)2984544 <br /> DATE 19 / <br /> RECEIVED $ <br /> FROM 4f <br /> Cl❑ CASH <br /> FOR di/ ff'�6' /�/^� ! u ❑ MOCK <br /> AMOUNT OF ACCOUNT...........5` ' <br /> �1 Q�I you! <br /> AMOUNT PAID... .... ..........$ <br /> BALANCE DUE............ ......$ 0Y <br />