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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M'1999077 <br />Montezuma County <br />Rob Englehart <br />1680 North Dolores Road <br />Cortez CO 813210000 <br />Receipt #: 22419 19� <br />Date: tTJz612016' <br />Permit: M1999077 <br />Payment Methoevenue <br />Code Fee Descri tionlPaidB Other'Entit !Nate <br />mount °:��f. lCheck <br />#29625 <br />Minerals Annual Fees2016 <br />Receipt Total: 1!791.00 <br />Page 1 of i <br />