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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2008001 <br /> Southwest Farms, Inc. Receipt#: 20523 <br /> MEDBOX Date: 11/03/2015 <br /> 600 Wilshire Blvd Ste 150 <br /> Permit: M2008001 <br /> Los Angeles CA 900170000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> 3434bjc 4300-MSOO Minerals Succession of Operators $144.00 <br /> M2008001 paid by MEDBOX Inc <br /> Receipt Total: $144.00 <br /> BANK OF SPRINGFIELD <br /> <br /> <br /> MEDBOX, INC. <br /> 600 WILSHIRE BLVD#1500 <br /> LOS ANGELES,CA 90017 10/23/2015 <br /> 1 <br /> 0 <br /> PAY TO THE D'vision of Reclamation, Mining, &Safety $ **144.00 <br /> ORDER OF <br /> One Hundred Forty-Four and 00/100************************************************************************************* <br /> DOLLARS ' <br /> Division of Reclamation, Mining, &Safety <br /> 1313 Sherman St., Room 215 <br /> Denver, CO 80203 <br /> NP <br /> a ooew) -- -.....___. -._..---._._.__.._.. _.._.___ <br /> AUT I1i1Rl�'F-D�IGNF{TU(1[ <br /> MEMO Application Fee I • <br /> Page 1 of 1 <br />