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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1984168 <br />Williams Fork Mining Company <br />000000000 <br />Receipt #: 20475 <br />Date: 10/26/2015 <br />Permit: M1984168 <br />Payment Method Revenue Code Fee Description/Notes Amount <br />055423 SDT 4300-MAFO Minerals Annual Fees <br />M1984-168 <br />791.00 <br />Receipt Total: 791.00 <br />Page 1 of 1