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DIV. jN OF MINERALS AND GEOLOGY N D 25452 <br /> �? / <br /> DATE , 0 19 7� <br /> RECEIVED !" y $ <br /> FROM A�J/lam T"_�ii C1�d J+J'A-A <br /> \1 <br /> DOLLARS <br /> Cl CASH <br /> FOR_Y.d/��A ^' 4O. f•/1- S� ' o� I/ '-� M.O K 0 <br /> AMOUNT OF ACCOUNT....... ...$ <br /> AMOUNT PAID...................$ <br /> BALANCE DUE...... .. .........$ BY ` ��/ '.�7J✓�., <br />