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Fremont County <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1979216 <br />111111111 <br />Receipt #: 16636 <br />Date: 01/06/2014 <br />Permit: M1979216 <br />mer <br />q&jVAU"AjjjWue <br />Code <br />Notes <br />Amount <br />106016 msr <br />4300 -01 <br />Minerals Annual Fees <br />M1979 -216 <br />$323.00 <br />Receipt Total: <br />$323.00 <br />Page 1 of 1 <br />