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Division of Reclamation, Mining, and Safety <br />Fee Receipt for MI 982154 <br />Farnsworth Construction and Gravel Compan <br />Patricia Farnsworth <br />175 Hwy 133 <br />Paonia CO 814280000 <br />Receipt #: <br />Date: <br />Permit: <br />25471 <br />10/31/2017 <br />M1982154 <br />Page 1 of 1 <br />Check #13268 <br />4300-MAFO <br />Minerals Annual Fees <br />$323.00 <br />User: sdt <br />Payer: Farnsworth Construction Co. <br />Due 1115117 <br />Receipt Total: <br />$323.00 <br />Page 1 of 1 <br />