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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2005012 <br /> Nick H. Gray Receipt#: 22753 <br /> Nick Gray Date: 01/10/2017 <br /> 584 65.30 Rd. <br /> Permit: M2005012 <br /> Montrose CO 814010000 <br /> Payment Method Revenue Code Fee Description/Paid By Other Entity/Notes Amount <br /> Check#1504 4300-MAFO Minerals Annual Fees $791.00 <br /> Black Canyon Aggregate, Inc. <br /> Due 01/10/17 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />