2016-06-23_REPORT - M2015022

• Permit No: M2015022
• IBM Index Class Name: Report
• Doc Date: 6/23/2016
• Doc Name: Annual Fee/Report Notice
• From: Lazy H Inc
• To: DRMS
• Annual Report Year: 2016
• Email Name: TOD
• Media Type: D
• Archive: No

Division of Reclamation, Mining, and Safety
Fee Receipt for M2015022
Lazy H Inc Receipt#: 21708
William Havengar Date: 06/23/2016
34449 County Road 10
Permit: M2015022
Keenesburg CO 806430000
Payment • • • •e Fee Description/Notes Am•
Check#25577 4300-MAFO Minerals Annual Fees $504.00
Receipt Total: $504.00
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