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DIVISION OF MINERALS AND GEOLOGY N~ 25470 I <br />(n7 nn _ DATE ~ /~ S 19 r~ <br />FROM EO ~0.titD~C. DL--. A . ~ (~ $ a a ~ <br />i <br />l ~ 'vO <br />TW U N u.... ~A. '~ . ,.D,,,. ~ ~` rw 11L ~ ~ DOLLARS { <br />^ CASH 1 <br />19.CHECK I <br />FOR f~,n~. op, rn- SS-~6S ~S$i ^M.O. <br />AMOUNT OF ACCOUNT. .........$ <br />~~IQVI~ OU~ ' <br />I' AMOUNT PAID ....... ....... ...8 <br />~l BALANCE DUE ...................5 BV ~Y ! ~ ~ I <br />