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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1984O4O <br /> Larry L Chartier Receipt#: 29323 <br /> Larry Chartier Date: 09/16/2019 <br /> 21305 Road 28.5 <br /> Permit: M1984040 <br /> Brush CO 807230000 <br /> Check#8904 4300-MAFO Minerals Annual Fees $323.00 <br /> User: SLB <br /> Replacement for NSF and subsequent incorrect <br /> amount payments. <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />