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III IIIIIIIIIIIII III <br />ass <br /> <br /> DIVI51~ . OF MINERALS AND GEOLOGY IV <br />~ <br />2578 <br />5 <br /> ,, <br />// <br />8 <br />__ //// <br />DATE x'19 /`~ <br />RECEIVED $ <br />FROM Q~f~.~ N ~-l1 <br /> ~ ~ <br /> <br /> o ^ CASH <br />FOR ~ ~~O ~ o~ ~O ~~ <br />M. <br /> AMOUNT ACCOUNT...... .....$ '1lQll r~ QUI <br />AMOUNT PAID . ......... .. ...$ IA /l <br /> BALANCE DUE ....... ...........$ BY <br /> <br />