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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1987097 <br /> 01 Conejos County Receipt#: 25693 <br /> Tressesa Martinez Date: 12/12/2017 <br /> P.O. Box 157 <br /> 6683 County Rd 13 Permit: M1987097 <br /> Conejos CO 811290000 <br /> Payment Method Revenue'pode Fee Description/Notes Amount <br /> Check#035403 4300-MAFO Minerals Annual Fees $791.00 <br /> User: sdt <br /> Payer: Board of County Commissioners Conejos <br /> County Treasurer Road and Bridge Fund <br /> Due 8/18/17 <br /> Receipt Total: $791.00 <br /> Page 1 of 1 <br />