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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1992045 <br /> Gold Basin Mine, LLC, c/o Simpson Estates Receipt#: 22646 <br /> Laurens Leffingwell,Jr. Date: 12/09/2016 <br /> 30 N. La Salle St., Ste 1232 Permit: M1992045 <br /> Chicago IL 606020000 <br /> Payment Method Revenue Code Fee Description/Paid By Other Entity/Notes Amount <br /> Check#1162 4300-MAFO Minerals Annual Fees $259.00 <br /> R Squared Incorporated <br /> Due 12/26/16 <br /> Receipt Total: $259,00 <br /> Page 1 of 1 <br />