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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2019007 <br /> astroid explorations Hc Receipt#: 28123 <br /> Jess Jensen Date: 02/07/2019 <br /> 11268 Canary Lane Permit: M2019007 <br /> Parker CO 801380000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> Check#2464 4300-MAPP Minerals Application Fees $288.00 <br /> User: bjc <br /> Payer: Jess John Jensen & Melinda R Jensen <br /> Receipt Total: $288.00 <br /> JESS JOHN JENSEN 82-504/1070 2464 <br /> MELINDA R.JENSEN <br /> 11268 CANARY LN. DATE ISl/ <br /> PARKER,CO 80138 <br /> 9 <br /> PAY TO (O tizotat. 40sdf�G{Qyr��M �' UsJq I $ 2 " <br /> THE ORDER <br /> r(OF a 0 1, V <br /> lkAn 4€, int q . o4 UKsGp -DOLLARS n <br /> I/ <br /> IABANK <br /> www.efirstbank.com4 <br /> MEMO r[SICR-0(Ji. yl.01KILIMSLLCh4cncr 141,4144..LJ� J Iud�.. NP <br /> SPECIAL,WAY <br /> Page 1 of 1 <br />