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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2O13O28 <br />Western States Minerals,LLC <br />Randy Burks <br />7964 E. Homestead Rd, <br />Parker CO 801380000 <br />Receipt #: <br />Date: <br />Permit: <br />25486 <br />fillifflicyKIZfl <br />M2013028 <br />' <br />Check #0474206265 <br />4300-MAFO <br />Minerals Annual Fees <br />$259.00 <br />User sdt <br />Due 1114117 <br />Receipt Total: <br />$259.00 <br />Page 1 of 1 <br />