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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for Minerals <br /> Josephine Bassi Receipt#: 23572 <br /> Josephine Bassi Date: 05/30/2017 <br /> 2046 Lake Ave <br /> Permit: Minerals <br /> Pueblo, CO 810040000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#1521 4300-MSOO Minerals Succession of Operators $144.00 <br /> User: bjc <br /> Payer: Bassi North Farm, LLC <br /> Receipt Total: $144.00 <br /> 1521 <br /> BASSI NORTH FARM LLC <br /> PH 719-561-8054 <br /> 2046 LAKE AVE. /'� <br /> PUEBLO,CO 81004 / -- 82-201,1021 <br /> DATE/ f PAY <br /> j" TO THE <br /> s1 ORDER OF U— - - - <br /> � I <br /> Community Banks <br /> of Colorado <br /> 877.877.0395 cobnks.com <br /> ' <br /> FOR <br /> III <br /> �I �� ��c.LJ—,[/(� <br /> Page 1 of 1 <br />