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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1977459 <br /> Lake County Receipt#: 21792 <br /> Brad Palmer Date: 07/08/2016 <br /> P.O. Box 952 <br /> Permit: M1977459 <br /> Leadville CO 804610000 <br /> Payment • • Revenue Code • • • Amount <br /> Check#093956 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br /> 11 <br />