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<br /> D14 !N OF MINERALS AND GEOLOGY _ ~ 0 2 4 0 ~ Z <br />" <br />1 <br />' <br /> - ~ - DATE ~ ~ 19 <br />j <br />~ <br />` <br /> RECEIVED ~ $~ <br />FRD <br /> <br /> ` ~ Li1 / °r ~ RS <br /> <br /> //~/y/1 c ~/ ^ CASH <br />FOR CL 71/f~ C Q 17 ! - O ~' 'T~ ~ ~.~ O p. <br /> AMOUNT OF OUNT.......... $ <br />AMOUM PAID ....... ...........$ Q ~ U ! <br /> BALANCE DUE ................ ..$ BY <br /> <br />