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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2009093 <br /> Theisen Mineral Receipt#: 21700 <br /> James Theisen Date: 06/22/2016 <br /> 1251 Bailey Dr. Permit: M2009093 <br /> Brighton CO 806030000 <br /> Payment . • Revenue Code • . . Amount <br /> Check#339 4300-MAFO Minerals Annual Fees $323.00 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />