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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2005080 <br /> Allen Drilling and Excavating Receipt#: 22221 <br /> Jack Allen Date: 09/23/2016 <br /> 651 Hwy 285 <br /> P.O. Box 398 Permit: M2005080 <br /> Fairplay CO 804400000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#9255 4300-MAFO Minerals Annual Fees $791.00 <br /> Due 10/24/16 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />