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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2005012 <br />Nick H. Gray <br />000000000 <br />Receipt #: 20779 <br />Date: 01/08/2016 <br />Permit: M2005012 <br />Payment Method <br />Revenue Code <br />Fee Description/Notes <br />Amount <br />16073 SDT <br />4300-MAFO <br />Minerals Annual Fees <br />M2005-012 <br />$791.00 <br />Receipt Total: I <br />$791.00 <br />Page 1 of 1 <br />