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RECEIVED <br /> SEP 2 0 2017 <br /> r' . - '1^h! OF RECLAMATION, <br /> Division of Reclamation, Mining, and Safety <br /> &SAFETY-MINERALS:4G G Fee Receipt for M1991080 v' <br /> Russell Van Egmond Receipt#: 25242 <br /> Cathleen Van Egmond Date: 09/20/2017 <br /> 546 Doe Valley Rd. <br /> Permit: M1991080 <br /> Guffey CO 808200000 <br /> MethodPayment Revenue Code • • . Amount <br /> Check#14738 4300-MAFO Minerals Annual Fees $323.00 <br /> .-User: MSR <br /> P Egmond Services Inc. <br /> 2015 <br /> Check#14738 4300-MAFO Minerals Annual Fees $323.00 <br /> User: MSR <br /> Payer: Van Egmond Services, Inc. <br /> 2016 <br /> Receipt Total: F $646.00 <br /> Page 1 of 1 <br />