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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2017012 <br />801270000COLittleton <br />8057 S. Vermejo Peak <br />Jeffrey Forrest <br />Receipt #: <br />04/07/2017 <br />23216 <br />Date: <br />M2017012Permit: <br />Amazonite Mining, LLC <br />Fee Description/NotesRevenue CodePayment Method Amount <br />Check #336 $1,006.004300-MAPP Minerals Application Fees <br />User: MSR <br />Payer: Jeffrey S. Forrest or Betsy C. Forrest <br />new application <br />$1,006.00Receipt Total: <br />Page 1 of 1