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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2000073 <br /> XTO Energy Inc. Receipt#: 25712 <br /> Kelly Kardos Date: 12/18/2017 <br /> P.O. BOX 6501 <br /> Permit: M2000073 <br /> ENGLEWOOD CO 801550000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> Check#8120557 4300-MSOO Minerals Succession of Operators $144.00 <br /> User: bjc <br /> Receipt Total: $144.00 <br /> THE ORIGINAL DOCUMENT HAS A WHITE REFLECTIVE WATERMARK ON THE BACK.HOLD AT AN ANGLE TO VIEW.DO NOT CASH IF NOT PRESENT � 4., <br /> P ,,-' z//, <br /> // Y''' <br /> 74:,-. . <br /> PM Ib% %;STO ENERGY 1*. Otibank,l�1.A: '\ <br /> ' ,8101-00s-'ON ST. TOItT WORTI I,TEXAS 76102-6293 ; _ ,/One Penn's W ay=New ea$OLDF 19720,• 000$12'O"S7 <br /> i Iuo , 62-20,311 .. <br /> EXE 1 G Y' ', ," CHECK NO. 000$120557 • VENDOR NO. 0037945 DATE 12/07/17 <br /> EXACTLY ONE HUNDRED FORTY-FOUR DOLLARS AND ZERO CENTS pAY$ S144.00 <br /> • <br /> VOID AFTER 90 DAYS <br /> 000021 120717 VENDOR <br /> PAY TO THE STATE OF COLORADO DIVISION OF at. ��ORDER OF: RECLAMATION MINING & SAFETY M 1t':"� <br /> DEPT OF NATURAL RESOURCES - <br /> 1313 SHERMAN STREET ROOM 215 AUTHORIZED SIGNATURE <br /> DENVER, CO 80203 <br /> on aafldbft3 <br /> Page 1 of 1 <br />