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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004043 <br />Universal Landscape & Aggregate Supply, Inc <br />000000000 <br />Payment Method Revenue Code <br />1662bjc <br />4300-MSOO <br />Receipt #: 19950 <br />Date: 07/24/2015 <br />Permit: M2004043 <br />Fee Description/Notes Amount <br />Minerals Succession of Operators <br />M2004043 paid by Tortorice Ranch - Christine Tortorice <br />$144.00 <br />Receipt Total: 1 $144.00 <br />0 <br />o' <br />0 <br />TORTORICE RANCH <br />PH 719-846-2333 <br />17512 CR 83 <br />Trinidad, CO 81082 <br />Pay to <br />the order of <br />International Bank <br />Date <br /> <br />95-0024/1022 <br />- eE=%4 , Zits /Vieljet, .fie $ > � <br />for- -.212-__4_'-_/,_44z , c„7, z '2744.1 7-e-1( <br />c4'6. <br /> <br /> <br />MP <br />Page 1 of 1 <br />