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Division of Reclamation, Mining, and Safety <br />Fee Receipt for Minerals <br />Receipt #: <br />1666 <br />Brian M Ocepek <br />510 Vance St <br />Lakewood CO 802261633 <br />265 ~ 4400 ~ Mineral Copies <br />M-1977-205 <br />Date: <br />Permit: <br />10!09/2007 <br />Minerals <br />$5.00 <br />Page 1 of 1 <br />