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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1990144 <br /> R. Lewis Fillmore Receipt#: 22664 <br /> R. Lewis Fillmore Date: 12/15/2016 <br /> 63985 Highway 96 E <br /> Permit: M1990144 <br /> Boone CO 810250000 <br /> Payment Method Revenue Code Fee Description/Paid By Other Entity/Notes Amount <br /> Check#1976 4300-MAFO Minerals Annual Fees $791.00 <br /> Due 06/15/16 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />