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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2009093 <br /> Theisen Mineral Receipt#: 23680 <br /> Suzanne Theisen Date: 06/19/2017 <br /> 1251 Bailey Dr. Permit: M2009093 <br /> Brighton CO 806030000 <br /> W M <br /> 'AM�f 1;11t: 7- <br /> i Z�i' " o w 0 I v5 77A <br /> Check#7428 4300-MAFO Minerals Annual Fees $323.00 <br /> User: sdt <br /> Payer: James A Lancy <br /> Due 6/22/17 <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />