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Division of Reclamation, Mining, and Safety <br />Fee Receipt for Minerals <br />Mason King <br />Mason King <br />P.O. Box 68 <br />Cope CO 808120000 <br />Receipt #: <br />Date: <br />Permit: <br />36093 <br />10/26/2021 <br />Minerals <br />Payment •• Revenue Code• • •Amount <br />Check #3660 5700 Minerals Civil Penalty/Violation Fines $323.00 <br />User: AHD <br />Infraction Number: MV-2021-019 <br />Receipt Total: $323.00 <br />Page 1 of 1 <br />