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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2000040 <br /> Medicine Bow - Routt National Forest USDA F Receipt#: 21782 <br /> Nate Davis Date: 07/06/2016 <br /> 2468 Jackson St. <br /> Permit: M2000040 <br /> Laramie WY 820706535 <br /> MethodPayment Revenue Code • • • AmounIMI <br /> Check#1146 4300-MAFO Minerals Annual Fees $323.00 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br /> i <br />