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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1983106 <br /> Cheyenne County Receipt#: 24139 <br /> Marcy Brossman Date: 09/06/2017 <br /> P.O. Box 567 <br /> Permit: M1983106 <br /> Cheyenne Wells CO 808100000 <br /> MethodPayment Revenue Code • • • Amount <br /> Check#81574 4300-MAFO Minerals Annual Fees $791.00 <br /> User: MSR <br /> 2017 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />