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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1987092 <br />Jordan C. and Jone L. Burdick <br />000000000 <br />Receipt #: <br />Date: <br />Permit: <br />19889 <br />07/15/2015 <br />M1987092 <br />1069 SDT <br />4300-MAFO <br />Minerals Annual Fees <br />$323.00 <br />M 1987-092 <br />Receipt Total: 1 $323.00 <br />Page 1 of 1 <br />