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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1999083 <br />Cheyenne County <br />Marcy Brossman <br />P.O. Box 567 <br />Cheyenne Wells CO 808100000 <br />Check #79848 1 4300-MAFO I Minerals Annual Fees <br />Due 10/19/16 <br />Receipt #: <br />Date: <br />Permit: <br />22311 <br />10/11/2016 <br />M1999083 <br />$323.00 <br />Receipt Total: 1 $323.00 <br />Page 1 of 1 <br />