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DIVI`"'~N OF MINERALS AND GEOLOGY V °_ 22yy6 6 6 5 <br />DATE ~ 19~ <br />//~-/~/J i <br />RREOCnE,I'VED / //~J ~ ~ /J/' /~~ $ <br />Y <br />~ ~~ DOLLARS <br />/'~ <br />'7 ~~ /~7 %IZ J =Jd o CHECK <br />FOR ^ M.0. <br />AMOUNT OF ACCOUNT..... .....$ <br />~ha ¢ ou l <br />AMOUNT PAID .................$ ,~ <br />BALANCE DUE ....... ..........$ ~6Y <br /> <br />