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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1980201 <br /> Mathias Concrete Inc Receipt#: 22346 <br /> Thomas Mathias Date: 10/14/2016 <br /> 1500 N. Farm Rd. <br /> P.O. Box 266 Permit: M1980201 <br /> Monte Vista CO 811440000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#14287 4300-MAFO Minerals Annual Fees $791.00 <br /> 2016 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />