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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1981058 <br />Thomas F & Ginger L Latham <br />000000000 <br />017080 msr 1 4300 -MAFO I Minerals Annual Fees <br />M1981 -058 paid by Kirkland Construction LLLP <br />Receipt # <br />Date <br />Permit: <br />18191 <br />09/15/2014 <br />M1981058 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />