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DIVISION OF MINERALS AND GE�.,WGY N 2 2 <br /> DATE �/�19 <br /> RFCENED $Fz <br /> FROM ' L/.�` <br /> DOLLARS <br /> �1 /y/� ❑CASH <br /> CHEC <br /> FOR/ l / .�lJ �� �(� ❑ M.O.K <br /> AMOUNT OF ACCOUNT ..........$ %�-/ `YI � 1 1 <br /> arn� �� oul <br /> AMOUNT PAID................ ..$ <br /> BALANCE DUE....... ......... .$ <br />