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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2001052 <br /> Kit Carson County Receipt#: 21894 <br /> Dave Hornung Date: 07/28/2016 <br /> P0 Box 160 <br /> Permit: M2001052 <br /> Burlington CO 808070000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#121206 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br /> 13 <br />