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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1976018 <br /> North Weld Gravel Receipt#: 22161 <br /> LeRoy Bellmore Date: 09/14/2016 <br /> 13480 Weld County Rd 100 <br /> Permit: M1976018 <br /> Nunn CO 806489700 <br /> Asa sseSig <br /> Check#2510 4300-MAFO Minerals Annual Fees $791.00 <br /> Due 10/17/2016 <br /> Receipt Total: $791.0 <br /> —01 <br /> Page 1 of 1 <br />