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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1983178 <br />Bent County <br />000000000 <br />26053 jwd 4300 -01 1 Minerals Annual Fees <br />M- 1983 -178 <br />Receipt # <br />Date <br />Permit <br />16198 <br />10/17/2013 <br />M1983178 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />