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Willits Company, Inc. <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2010034 <br />om <br />Receipt #: <br />Date: <br />Permit: <br />19758 <br />06/22/2015 <br />M2010034 <br />Payment Method Revenue Code Fee Description/Notes A.,,,,,,.,+ <br />763793bjc <br />4300-MSOO <br />Minerals Succession of Operators <br />$144.00 <br />M2010034 paid bySYZYGYEnterprises, LLC <br />DOCUMENT IS PRINTED ON CHEMICAL REACTIVE PAPER WITH INVISIBLE FIBER: <br />First National Bank <br />o 205 West Oak Street • Fort Collins, CO 80522-0578 <br />x <br />2 REMITTER: SYZYGY ENTERPRISES, LLC <br />0 <br />0 <br />0 <br />0 <br />x <br />W PAS, EYACTLY **144 DOLLARS AND 00 CENTS** <br />PAY TO THE ORDER OF: DWS <br />F <br />4 <br />V <br />r <br />Q <br />aor©-03y <br />111M <br />I Receipt Total: 1 $144.00 <br />SIDE INCLUDES MICROPRINTED ENDORSEMENT LINES <br />92_26 <br />CASHIER'S CHECK 1070 <br />CHECK <br />MBER: <br />NUMBER: 763793 <br />DATE: 06118/2"015 <br />144.00 <br />TWOSES REQUIRED OVER $100,000 %- <br />AUTHORIZED SIGNATURE <br />Page 1 of 1 <br />m <br />i <br />