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Fremont County <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1979216 <br />111111111 <br />Receipt #: 18704 <br />Date: 12/29/2014 <br />Permit: M1979216 <br />Payment Method <br />Revenue Code <br />- 'Fee Description /Notes <br />1-1-0-8-383 msr <br />Minerals Annual Fees <br />11 <br />Receipt Total: $323.00 <br />Page 1 of 1 <br />