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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1994114 <br />Kagan & Son, L.L.C. <br />Andrew and Rebecca M Kagan <br />555 Ernest Avenue <br />Westcliffe CO 812520000 <br />Receipt #: <br />Date: <br />Permit: <br />22277 <br />10/03/2016 <br />M1994114 <br />Payment Metttod <br />Revenue C <br />......v. <br />Fee_ DescriptionlNotes� .. ar ... <br />Amount <br />Check <br />Minerals Annual Fees <br />2016 <br />Receipt Total: $791.00 <br />Page 1 of 1 <br />