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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M2019057 <br /> Jacob Ulrich Receipt#: 30623 <br /> Jacob Ulrich Date: 11/20/2019 <br /> 17619 Leisure Lake Dr Permit: M2019057 <br /> Monument CO 801320000 <br /> Payment Method Revenue Code Fee Description/Notes Amount <br /> Check#2361 4300-MAPP Minerals Application Fees $288.00 <br /> User: sdt <br /> Payer: Jacob Ulrich Kerrie Ulrich <br /> Receipt Total: $288.00 <br /> Page 1 of 1 <br />