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Bent County <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1991086 <br />25905 jwd 14300-01 1 Minerals Annual Fees <br />M- 1991 -086 <br />Receipt #: 16117 <br />Date: 10/08/2013 <br />Permit: M1991086 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />