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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2003024 <br /> Phillips County Receipt#: 21386 <br /> Randy Schafer Date: 04/29/2016 <br /> 221 S. Interocean Ave. <br /> Permit: M2003024 <br /> Holyoke CO 807340000 <br /> Payment • • Revenue Code • • • Amount <br /> Check#37569 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />