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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2001070 <br /> Wallace F. Burtis Receipt#: 22018 <br /> Wallace Burtis Date: 08/16/2016 <br /> 66 Dartmouth Ave. <br /> Permit: M2001070 <br /> Pueblo CO 810050000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#8923 4300-MAFO Minerals Annual Fees $259.00 <br /> 2016 <br /> Receipt Total: $259.00 <br /> Page 1 of 1 <br />