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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1981068 <br /> Grant Bros Construction Ltd Receipt#: 22209 <br /> Dan or Doug Grant Date: 09/22/2016 <br /> P.O. Box 1027 <br /> Permit: M1981068 <br /> Basalt CO 816210000 <br /> Payment • • Revenue Code • • • Amount <br /> Check#11412 4300-MAFO Minerals Annual Fees $791.00 <br /> Due 10/27/16 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />