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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2O1OO54 <br /> Timothy D.Williams&Betty J.Williams Receipt#: 22634 <br /> Timothy Williams Date: 12/08/2016 <br /> P.O. Box 455 <br /> Permit: M2010054 <br /> Walsenburg CO 810890000 <br /> Payment Method Revenue Code Fee Description/Paid By Other Entity/Notes Amount <br /> Check#5310 4300-MAFO Minerals Annual Fees $323.00 <br /> Tim or Pam Williams <br /> Due 12/08/16 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />