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8/9/23, 10:50 AM Receipt <br /> United States Department of the Interior <br /> Bureau of Land Management w Receipt <br /> DIV OF SUPPORT SERVICESr <br /> CO STATE OFFICE, PO BOX 151029 <br /> LAKEWOOD,CO 80215 No: 5221088 <br /> Phone: (303)239-3600 <br /> Transaction#: 5369180 <br /> Date of Transaction: 08/09/2023 <br /> CUSTOMER: <br /> GEORGE L QUIST <br /> 1849 TRAIL CREEK RD <br /> LAKE GEORGE,CO 80827 US <br /> LINE QTY DESCRIPTION REMARKS PRICE UNIT <br /> TOTAL <br /> MLRS MINING CLAIMS/MINING CLAIMS-EXISTING-MLRS ONLY/ <br /> PROOF OF LABOR/ASSESSMENT <br /> 1 10.00 CASES: C0101312051/$15.00, C0101313130/$15.00, -n/a- 150.00 <br /> C0101314486/$15.00,C0101316649/$15.00,C0101338549/$15.00, <br /> C0101339213/$15.00, C0101423463/$15.00,C0101425663/$15.00, <br /> C0101425686/$15.00, C0102521436/$15.00 j <br /> TOTAL: $150.00 <br /> PAYMENT INFORMATION <br /> AMOUNT: v50.00 POSTMARKED: N/A <br /> TYPE:1 CHECK RECEIVED: 08/09/2023 <br /> CHECK NO: 1383 <br /> NAME: GEORGE L QUIST <br /> QUIST,GEORGE L <br /> 1849 TRAIL CREEK RD <br /> LAKE GEORGE CO 80827 US <br /> REMARKS <br /> NOTICE(S) <br /> Notice to When you provide a check as payment, you authorize us either to use information from your check to make a <br /> Customers one-time electronic fund transfer from your account or to process the payment as a check transaction. For <br /> Presenting inquiries please call the BLM office listed above. <br /> Checks: q <br /> A Privacy Act Statement required by 5 U.S.C. § 552a(e)(3) stating our authority for soliciting and collecting <br /> the information from your check,and explaining the purposes and routine uses which will be made of your <br /> 4' check information, is available from the Federal Register at: <br /> Privacy Act: (https://www.federalregister.gov/articles/2003/02/04/03-2521/privacy-act-of-1974-as-amended-system-of- <br /> records), or by calling toll free at(1-866-945-7920)to obtain a copy by mail. Furnishing the check <br /> l'. 4 information is voluntary,but a decision not to do so may require you to make payment by some other <br /> - method. <br /> This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic <br /> record contained therein. <br /> https://ilmocop0ap6165.blm.doi.net/cgibin/cbsp/cbs_start2 1/1 <br />