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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1980233 <br /> Costilla County Receipt#: 25684 <br /> Christopher Rodriguez Date: 12/11/2017 <br /> P.O. Box 130 <br /> ^ Permit: M1980233 <br /> San Luis CO 811520000 �� 1 <br /> Payment Method Revenue Code Fee Descriptiorii/Notes Amount�� <br /> Check#18120 4300-MAFO Minerals Annual Fees $323.00 <br /> User: sdt <br /> Payer: Costilla County General Fund Accounts Payable <br /> Due 12/1111 <br /> C ck#18120 5700 Minerals Civil Penalty/Violation Fines 3.00 <br /> User: sdt <br /> Payer: Costilla County General Fund Accounts Payable <br /> Infraction Number: MV2017053 <br /> Receipt Total: $646,00 <br /> RECEIVED <br /> DEC 11 Z017 <br /> DIVISION OF RECLAMATION, <br /> MINING&SAFETY-MINERALS <br /> FEE -US <br /> Page 1 of 1 <br />