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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2005065 <br />Jack Clark, Jr. <br />000000000 <br />Receipt #: 20636 <br />Date: 11/27/2015 <br />Permit: M2005065 <br />Payment Method Revenue Code <br />Fee Description/Notes Amount <br />6542 msr <br />4300-MAFO <br />Minerals Annual Fees <br />M2005-065 <br />$791.00 <br />Receipt Total: <br />$791.00 <br />Page 1 of 1 <br />