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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2000018 <br /> Cheyenne County Receipt#: 21443 <br /> Marcy Brossman Date: 05/09/2016 <br /> P.O. Box 567 <br /> Permit: M2000018 <br /> Cheyenne Wells CO 808100000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> Check#78977 4300-MAFO Minerals Annual Fees $323.00 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />