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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1993030 <br /> Receipt#: 21488 <br /> Crystal Jack Mining, LLC <br /> Joseph Dorris Date: 05/19/2016 <br /> 2920 Cedar Hts. Dr. <br /> Permit: M1993030 <br /> Colorado Springs CO 809040000 <br /> MethodPayment Revenue Code Fee Description/Notes Amount <br /> Check#8980 4300-MSOO Minerals Succession of Operators $115.00 <br /> Receipt Total: $115.00 <br /> pia 89830 <br /> j� PINNACLE 5 MINERALS LLC 6-86 <br /> 1" JOSEPH L. OR SUSAN M. DORRIS <br /> ?� P.O. BOX 413 PH. 719-685-4479 <br /> MANITOU SPRINGS, CO 80829 Nat na1 Parlyj� <br /> UMB BANK NA ; <br /> Y <br /> Page 1 of 1 <br />