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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004053 <br />Rivera's Excavation <br />000000000 <br />Receipt #: 20757 <br />Date: 12/29/2015 <br />Permit: M2004053 <br />Payment Method <br />Revenue Code <br />Fee Description/Notes <br />Amount <br />7819 SDT <br />4300-MAFO <br />Minerals Annual Fees <br />M2004-053 <br />$323.00 <br />Receipt Total: $323.00 <br />Page 1 of 1 <br />