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<br /> DIVISION OF'•MINERALS AND GEOLOGY N~ 25455 <br /> ~~ <br />- - DATE 19 9_~ <br /> REC~VED ~ `~wy~ u^ n S <br />FARM ~ ..LX a 7 <br /> <br /> <br /> ~, - sa- sa , 8 R-s~ , ~i <br />p <br />,casH <br /> { <br />A <br />/~ M 3 183,<3`Y (gJ~l'dEi I$9 ~ba~j07 ^M <br />FON f.A.....,. 1~-SZ4d ~"~ <br />O <br /> . <br />, <br />m-aa- a , 78~~' <br /> AMOUM OF ADCOUM...........5 ~+--'p /,~'^ <br />~ <br />' <br /> Q <br />r <br />t <br />-G <br />OU <br />AMOUNT PAID ...................5 V <br />/~ <br /> , <br />~ ( <br />/ <br />~ <br />/ <br />BALANCE DUE ...................5 8Y ~Y JJQ IAY <br /> <br />_... -.. . <br />