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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for MI977485 <br /> Baca County Receipt#: 22132 <br /> Dean Ormiston Date: 09/08/2016 <br /> 741 Main St.,Suite 1 <br /> Permit: M1977485 <br /> Springfield CO 810730000 <br /> ri <br /> Check#119859 4300-MAFO Minerals Annual Fees $791.00 <br /> (due 9/11/2016) <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />