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RECEIVED <br /> AUG 2 4 2016 <br /> DIVISION OF RECLAMATION, Division of Reclamation, Mining, and Safety <br /> (!!FE C'&SAFETY-MINERALS <br /> v , p Fee Receipt for M1977044 L-1 <br /> Costilla County Receipt#: 22060 <br /> Trinidad Martinez Date: '-�/24/2016 <br /> P.O. Box 130 <br /> Permit: M1977044 <br /> San Luis CO 811520000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#11287 4300-MAFO Minerals Annual Fees $323.00 <br /> 015 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />