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8/26124,9:11 AM Receipt <br /> United States Department of the Interior <br /> Bureau of Land Management Receipt <br /> DIV OF SUPPORT SERVICES <br /> CO STATE OFFICE, PO BOX 151029 <br /> LAKEWOOD, CO 80215 No: 5374830 <br /> Phone: (303) 239-3600 <br /> Transaction #: 5532606 <br /> Date of Transaction: 08/26/2024 <br /> CUSTOMER: <br /> BRENT ROVEDO <br /> 18049 E BELLEWOOD DR <br /> AURORA,CO 80015-2017 US <br /> LINE QTY DESCRIPTION REMARKS PRICE TOTAL <br /> MLRS MINING CLAIMS/MINING CLAIMS-EXISTING- <br /> MLRS1 4.00 ONLY/MAINTENANCE FEE -n/a- 800.00 <br /> CASES: C0101338104/$200.00, C0101342688/$200.00, <br /> C0101643499/$200.00, C0106353737/$200.00 <br /> TOTAL: $800.00 <br /> PAYMENT INFORMATION <br /> NOTE: Items will appear on credit card statement as "Bureau of Land Mgmt CO". <br /> 1 AMOUNT: 800.00 POSTMARKED: IN/A <br /> TYPE:1 CREDIT CARD RECEIVED: 08/26/2024 J <br /> NAME:I BRENT ROVEDO <br /> 118049 E BELLEWOOD DR <br /> I AURORA CO 80015-2017 US <br /> CARD NO: XXXXXXXXXXXX6757 AUTH CODE: 062733 <br /> NAME ON CARD: BRENT ROVEDO <br /> SIGNATURE: <br /> REMARKS <br /> NOTICE(S) <br /> Notice to When you provide a check as payment,you authorize us either to use information from your <br /> Customers check to make a one-time electronic fund transfer from your account or to process the payment as <br /> Presenting a check transaction. For inquiries, please call the BLM office listed above. <br /> Checks: <br /> Privacy Act: A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and <br /> collecting the information from your check, and explaining the purposes and routine uses which <br /> will be made of your check information, is available from the Federal Register at: <br /> https:/filmocopoap6165.blm.doi.net/cgibin/cbsp/cbs_start2 1/2 <br />