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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1991147 <br /> Belvedere Stone, LLC RECEIVE® Receipt#: 21706 <br /> William Johannsen JUN 2 3 2016 Date: 06/23/2016 <br /> c/o Ms. Ginny Kenley <br /> IV OF Steel Dr F RECLAMATION, Permit: M1991147 <br /> &'^SAFETY-WNERALS <br /> Colorado Springs CO 809070000 <br /> MethodPayment Revenue Code Fee Desci iption/Notes Amount <br /> Check#1023 4300-MAFO Minerals Annual Fees $323.00 <br /> *2016's Annual Fee only(Report/Map not rec'd) <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />