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III IIIIIIIIIIIII III <br />sss <br />DIVISION OF MINERALS AND GEOLC <br />RECEIVED <br />FOR ~ ~ <br />AMOUNT OF ACCDUNi.. ........$ <br />AMOUNT PAID ...................$ <br />BALANCE DUE .......... ........$ <br />N°_ 2668 <br />19_ <br />^ CASH <br />^ CHECK <br />_ O M.O. <br />~oul <br />