Laserfiche WebLink
i~rrurllriirr~iul <br /> <br /> DIVI'' ~N OF MINERALS AND GEOLOGY ~p 26017 <br /> DATE ~~ ~ ~V 19~ <br /> /~ <br />RECEIVED / ~ ~ ~ ~ $ aa.~. <br />U /1 P /~ <br />~1 i <br />/1~ <br />0 ~ <br />1 <br />FRO <br />M <br /> ~ <br />, <br />/ <br />/ <br />/ <br />~ <br />~ <br />~ <br />~~ <br />' <br />~ <br /> .~ip 7 <br />nr.!/ f.cJ i <br />/G/7~ <br />~iARs <br />1.~tm <br /> ~/J p~ C~ ^ CASH <br />FOR/P~1/!'~~ ~Q /~/- /~-~~ ~r~~6 ~-EFIOECK <br /> <br /> AMOUNT OF CCOUNT...........$ I^ '^ <br />~ <br />UI <br />Q <br /> 1 <br />Il <br />1l <br />AMOUNT PAID ......... .........5 <br /> BALANCE DUE ...................$ BY ~ <br /> <br />