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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977227 <br />MWCA, Inc. <br />Super Ex, LLC <br />270 S. 15th St <br />Canon City <br />CO 812120000 <br />Receipt #: 20948 <br />Date: 02/11/2016 <br />Permit: M1977227 <br />Payment Method <br />Revenue Code <br />Fee Description/Notes <br />Amount <br />1445 bjc <br />4300-MSOO <br />Minerals Succession of Operators <br />M1977-227 paid by Super XEX, LLC <br />$115.00 <br />Receipt Total: <br />$115.00 <br />SECURITY FEATURES INCLUDE TRUE WATERMARK PAPER, HEAT SENSITIVE ICON AND FOIL HOLOGRAM. =• <br />SUPER XEX, LLC <br />270 SOUTH 15TH STREET <br />CANON CITY, CO 81212 <br />PH. 719-588-7916 <br />PAY TO THE <br />ORDER OF Colorado Division of Reclamation, Mining & Safety <br />One Hundred Fifteen and No/ 100 Dollars <br />Colorado Division of Reclamation, Mining & Safety <br />1313 Sherman St, Room 215 <br />Denver, CO 80203 <br />MEMO USA <br />tib 0'77 2/7 <br />COLORADO EAST BANK & TRUST <br />PUEBLO, CO 81008 <br />1445 <br />82-157/1021 <br />1/15/16 <br />$115.00 <br />DOLLARS <br />A <br />10100141,50 LO 2 LO L5771: L 2 L987/39 <br />------------- --------------- <br />HORI D SIG <br />Page 1 of 1 <br />