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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1984117 <br />Fremont County <br />000000000 <br />Receipt #: <br />Date: <br />Permit: <br />18705 <br />12/29/2014 <br />M1984117 <br />Payment Method <br />Revenue Codes° <br />Feescription /Notes <br />Amount <br />1 I • j <br />Minerals Annual Fees <br />.;. <br />Receipt Total: $323.00 <br />Page 1 of 1 <br />