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III IIIIIIIIIIIII III <br />999 <br /> <br /> DIviON OF MINERALS AND GEOLOGY ~ N~ 25644 ~I <br /> _ GATE ~U~ ~s 193 <br /> RECEIVED <br />~ <br />$ 5~v <br />/,, <br /> ~ w ~ <br />_ <br />FRO w ~- ~ • ~ vtl <br />vim` <br /> ~~ <br /> DOLLARS <br /> <br /> (~ q ^ CASH <br />FOR(Z~YVr'\ -~c7 /~Z 'Q'6HECK <br />- ^ M <br />O <br /> . <br />. <br /> AMOUNT OF CCOUM...........$ 'A I^ <br />J QYIK D~I <br />AMOUNT PAID ...... ...... .....$ <br />x <br /> J <br />I <br />BALANCE OUE ...................$ BY <br /> <br />