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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1983119 <br /> Kiowa County Receipt#: 21848 <br /> Jack Howard Date: 07/20/2016 <br /> P.O. Box 100 <br /> Permit: M1983119 <br /> Eads CO 810360000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#090482 4300-MAFO Minerals Annual Fees $323.00 <br /> *This check covers Annual Fees for 5 permits. <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br /> S' <br />