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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1997061 <br /> Sedgwick County Receipt#: 21991 <br /> Matt Hansen Date: 08/12/2016 <br /> 223 S. Cedar <br /> Permit: M1997061 <br /> Julesburg CO 807370000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> Check#079457 4300-MAFO Minerals Annual Fees $323.00 <br /> 2016 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />