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<br /> DIVISION MINERALS AND GEOLC`GY N <br />_ ' 6 ~. <br />" <br />"r <br />J <br /> ----f <br />A <br />T <br />19 <br />D <br />E <br />>'/' <br />~~ <br /> ' <br />y <br />~ <br />ED ~ <br />D 7/ $ i <br /> ~ <br />((!!UU 7 ~/ <br />FROM <br /> <br /> OfO <br />_ <br />DOLLARS <br /> <br /> ^ CASH <br /> ~y~ ~/~ <br />~ ^ CHECK <br />~ <br /> ~~"77/ 'L~ <br />FOR <br />^ M.O. <br /> <br /> n,A /~' <br />AMOUNT OF ACCOUNT.. ........$ <br />~ ` <br />! <br /> UQU <br />Url <br />AMOUM PAID ...................$ U ~/ <br /> BALANCE DUE ...................$ <br /> <br />