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Theisen Mineral <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2009093 <br />[IIIIIIIIIIIIIIITI] <br />Receipt #: 19779 <br />Date: 06/23/2015 <br />Permit: M2009093 <br />Payment Method <br />Revenue Cod, -- <br />,.-.,.,W. . Fee Description/Notes - <br />Amort <br />1 • <br />11 1Minerals <br />Annual Fees11 <br />M2009-093 <br />Receipt Total: $323.00 <br />Page 1 of 1 <br />