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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1982189 <br /> Kit Carson County Receipt#: 22200 <br /> Paula Weeks Date: 09/21/2016 <br /> P.O. Box 160 <br /> Permit: M1982189 <br /> Burlington CO 808070000 <br /> MethodPayment Revenue Code . • . Amount <br /> Check#122415 4300-MAFO Minerals Annual Fees $323.00 <br /> Due 10/28/16 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />