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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M9 978267 <br />Otero County <br />Lex Nichols <br />13 West 3rd St., Room 206 <br />La Junta CO 810500000 <br />Receipt #: <br />Date: <br />Permit: <br />21834 <br />07/19/2016 <br />M1978267 <br />[ ymeni-ethod]Revenue_Code <br />._ .: _`'RIjjPFWWF— ee DescriptionlNotes�k:. <br />Check#108426 <br />Minerals Annual Fees <br />2016 <br />Receipt Total: $791.00 <br />Page 1 of 1 <br />