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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1981138 <br /> Baca County Receipt#: 21856 <br /> Peter Dawson Date: 07/21/2016 <br /> 741 Main St.,Suite 1 <br /> Permit: M1981138 <br /> Springfield CO 810730000 <br /> Payment • • Revenue Code • • • Amount <br /> Check#119331 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />