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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1977425 <br /> Larimer County Receipt#: 21366 <br /> Justin Hersh Date: 04/27/2016 <br /> P.O. Box 1190 <br /> Permit: M1977425 <br /> Fort Collins CO 805220000 <br /> MethodPayment Revenue Code • • . Amount <br /> Check#370245 4300-MTRO Minerals Technical Revision $216.00 <br /> TR02 <br /> Receipt Total: $216.00 <br /> Page 1 of 1 <br />