2016-11-14_REPORT - M1981148

• Permit No: M1981148
• IBM Index Class Name: REPORT
• Doc Date: 11/14/2016
• Doc Name: Annual Fee/Report/Map
• From: Chieftain South Mine
• To: DRMS
• Annual Report Year: 2016
• Email Name: MAC
• Media Type: D
• Archive: No

Division of Reclamation, Mining, and Safety
Fee Receipt for M1981148
General Shale Brick, Inc. Receipt#: 22509
Harold Stickler Date: 11/15/2016
1845 W Dartmouth Ave Permit: M1981148
Denver CO 801101308
Check#00927961 4300-MAFO Minerals Annual Fees $791.00
Due 11/01/16
Receipt Total: $791,00
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