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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1981138 <br />Baca County <br />Peter Dawson <br />741 Main St.,Suite 1 <br />Springfield CO 810730000 <br />Check #122804 1 4300-MAFO I Minerals Annual Fees <br />User: msr <br />2017 <br />Receipt #: <br />Date: <br />Permit <br />23901 <br />07/28/2017 <br />M1981138 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />