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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1988115 <br /> Kit Carson County Receipt#: 22542 <br /> Paula Weeks Date: 11/21/2016 <br /> P.O. Box 160 <br /> Permit: M1988115 <br /> Burlington CO 808070000 <br /> f o� ..�'�.L�=Jil3,.";laf�a,1� s "'f �� � • � �jt-' '�i�l4b�t��sS'E�' _ a ; <br /> Check#122964 4300-MAFO Minerals Annual Fees $323.00 <br /> Due 12/19/16 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />