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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2016067 <br /> Gary W Pollack Receipt#: 25208 <br /> Gary Pollack Date: 09/15/2017 <br /> P.O. Box 6063 <br /> Permit: M2016067 <br /> Colorado Springs CO 809340000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> Check#5217 4300-MAPP Minerals Application Fees $288.00 <br /> User: MSR <br /> Payer: Gary W. Pollack <br /> new application <br /> Receipt Total: $288.00 <br /> Page 1 of 1 <br />