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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2OO7O76 <br /> Cheyenne County Receipt#: 22812 <br /> Marcy Brossman Date: 01/19/2017 <br /> P.O. Box 567 <br /> Permit: M2007076 <br /> Cheyenne Wells CO 808100000 <br /> Payment Method Revenue Code Fee 11369bribtion/Paid By Other Entity/Notes Amount <br /> Check#80464 4300-MAFO Minerals Annual Fees $323.00 <br /> 2017 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />