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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2013028 <br /> Western States Minerals,LLC Receipt#: 22467 <br /> Randy Burks Date: 11/03/2016 <br /> 7964 E. Homestead Rd. <br /> Permit: M2013028 <br /> Parker CO 801380000 <br /> Payment Method Revenue Code Fee Description/Paid By Other Entity/Notes Amount <br /> Check#04764061 4300-MAFO Minerals Annual Fees $259.00 <br /> Due 11/4/16 <br /> Receipt Total: $259.00 <br /> Page 1 of 1 <br />