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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1 997094 <br /> el Siloam Stone, Inc. Receipt#: 22550 <br /> Ferd & Matt Mueller Date: 11/22/2016 <br /> 315 N. 7th St. <br /> Permit: M1997094 <br /> QCanon City CO 812120000 <br /> imU 7;W 5,,-I= <br /> Check#16503 4300-MAFO Minerals Annual Fees $323.00 <br /> Due 11/20/16 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />