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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1999024 <br />811520000COSan Luis <br />P.O. Box 130 <br />Mathew Valdez <br />Receipt #: <br />05/24/2017 <br /> 23515 <br />Date: <br />M1999024Permit: <br />Costilla County <br />Fee Description/NotesRevenue CodePayment Method Amount <br />Check #11943 $791.00 4300-MAF0 Minerals Annual Fees <br />User: MSR <br />2016 <br />$791.00 Receipt Total: <br />Page 1 of 1