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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001019 <br />Bent County <br />029420 SDT 14300-MAFO I Minerals Annual Fees <br />M2001-019 <br />Receipt #: <br />Date: <br />Permit: <br />19657 <br />06/03/2015 <br />M2001019 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />