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DIVISION OF MINERALS AND GEOLOGY <br />r <br />RECEIVED <br />~ ,281 <br />DATE ~ 19 <br />D. <br />/ ^ CASH <br />_ ^ CHECK <br />FOR ~~~~ ~ ~ ^ M.O. <br />AMOUNT OF ACCOUNT.... ......$ <br />AMOUNT PAID ............... .. .$ v//`a~~..K Vu ~U <br />BALANCE DUE . .............. ..$ BY /~/~'n~~~ <br />