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<br /> DIVISIC~~~F MINERALS AND GEOLOGY `~ 2 4 0 3 <br />3 <br /> ~C, <br />~? <br />- _ DATE ~'19.~_ <br /> ~\ (~ <br />OJ <br />$ <br />~ <br />ED <br /> 75 <br />I <br />FJ fig. F~(/w <br />GV.e-lt.Ll <br />~ ~Q....C~ <br />FADM <br /> / <br />2 <br />O MA~ <br />~ <br />L~ ~.yLa.~~n..~ "I 1.~+~' c.,...~. ~,[~Y,pOLLARS <br /> ( <br />~ <br />FOR ~.--"r-er YV~ - tSC-~-7~/ (~~,-13 p OAK <br /> <br /> AMOUNT OF ACCOUNT... .......$ (`'-p~I^ '^I^ <br />I <br />Q <br /> IIK O~ <br />AMOUNT PAID .............. ....$ V II <br />...... .....$ BV y 1 Y [QMy- <br />BALANCE DUE..... <br /> <br />