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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1994103 <br /> Costilla County Receipt#: 25683 <br /> Christopher Rodriguez Date: 12/11/2017 <br /> PO Box 130 <br /> Permit: M1994103 <br /> San Luis CO 811520000 <br /> MethodPayment • •e Fee Oescription/Notes <br /> Amount <br /> Check#18120 4300-MAFO Minerals Annual Fees $323.00 <br /> User: sdt <br /> Payer: Costilla County General Fund Accounts Payable <br /> Due 6/6/17 <br /> Check#18120 4300-MAFO Minerals Annual Fees $323.00 <br /> User: sdt <br /> Payer: Costilla County General Fund Accounts Payable <br /> Ila <br /> C #18120 5700 Minerals Civil PenaltyNiolation Fines $323.00 <br /> User: sdt <br /> Payer: Costilla Co nd Accounts Payable <br /> Infraction Numb r: MV2017052 <br /> $969.00 <br /> V:1V IF <br /> DFc 12017 <br /> T�7:4:4 IkMATwON <br /> Page 1 of 1 <br />