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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M 1992045 <br />Gold Basin Mine, LLC, c/o Simpson Estates <br />000000000 <br />1299 msr 1 4300 -MAFO I Minerals Annual Fees <br />M1992 -045 paid by George Robinson <br />Receipt #: <br />Date: <br />Permit: <br />18732 <br />01/05/2015 <br />M1992045 <br />$259.00 <br />Receipt Total: 1 $259.00 <br />Page 1 of 1 <br />