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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1984155 <br /> Dolores County Receipt#: 22041 <br /> Michael Davis Date: 08/19/2016 <br /> P.O. Box 608 <br /> Permit: M1984155 <br /> Dove Creek CO 813240000 <br /> Payment • . Revenue CodeDescription/Notes <br /> Check#502211 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />