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DIVISIC~OF MINERALS AND GEOLOGY pQ~ 24696 <br />/} - -~ OATE ~ ~ d` 193 <br />RECEIVED ( .,~ $ r~ <br />FROM ~-fJ <br />C2~ <br />"^C80LLAR5 <br />-7 2 ^ CASH <br />FOR~II.1!rJ ~ ~ / ~ 3 ~ /3i3 79 ~ acK <br />AMOUNT OF OUNT..... .....$ ~ ' <br />AMOUNT PAID .... .......... .....$ <br />flALANCE OUE ... ......... ....$ BY <br />