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Washington County <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004021 <br />111111111 <br />71607 SDT 14300-MAFO I Minerals Annual Fees <br />M2004-021 <br />Receipt #: <br />Date: <br />Permit <br />20167 <br />09/01/2015 <br />M2004021 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />