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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 #: 20949 <br />Date: 02/11/2016 <br />Permit: M1977227 <br />Payment Method Revenue Code <br />Fee Description/Notes Amount <br />3220bjc <br />4300-MSOO <br />Minerals Succession of Operators <br />M1977-227 paid by Super Ex,LLC <br />$29.00 <br />Receipt Total: <br />$29.00 <br />PAY TO THE <br />ORDER OF <br />High Country BANK <br />SUPER EX, LLC Offices in Salida, Buena Vista, and Canon City <br />270 S. 15TH ST. <br />CANON CITY, CO 81212-3904 <br />Colorado Division of Reclamation, Mining & Safety <br />82-7046-3021 <br />Twenty Nine and No/ 100 Dollars <br />¢Shield' Check Fad <br />%GB[@on 4 Banes. <br />Colorado Division of Reclamation, Mining & Safety <br />1313 Sherman St, Room 215 <br />Denver, CO 80203 <br />USA <br />MEMO <br />Lad 01- q-7)2-1 <br />000 3 2 2011' 1:30 2 7046 31:0 5 L800660 5u' <br />3220 <br />2/5/16 <br />a <br />0 <br />$29.00 <br />DOLLARS <br />3S" <br />8 <br />ZED SI ATURE <br />,t3c <br />Page 1 of 1 <br />