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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1983164 <br /> George F. Gallegos Receipt#: 22056 <br /> Gale Swafford Date: 08/24/2016 <br /> P.O. Box 575 <br /> Permit: M1983164 <br /> Romeo CO 811480000 <br /> MethodPayment Revenue Code • • • Amount I <br /> Check#310 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />