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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1984140 <br /> Prowers County Receipt#: 22103 <br /> Mark Dorenkamp Date: 09/01/2016 <br /> 109 E. Sherman St. <br /> Permit: M1984140 <br /> Lamar CO 810520000 <br /> ss • • • • • s <br /> Check#53230 4300-MAFO Minerals Annual Fees $323.00 <br /> 2016 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />