PERMFILE108168

• Permit No: M2004048
• IBM Index Class Name: Permit File
• Doc Date: 7/26/2004
• Doc Name: Supplemental Information
• From: Robert Daugherty
• To: DMG
• Media Type: D
• Archive: No

i~cya N~
United States Department of the Interior
Bureau of Land Management
SAN JUAN PUBLIC LANDS CENTER
15 BURNETT COURT
DURANGO, CO 81301 -3647
Phone: [phone]
hap://cbs.blm.gov/cgi birJcbslzorder
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tNo .' ;{" ~ $ c''t~,.'t.'w777042y ,
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Transaction #: 807242
Date of Transaction: 10/30/2003 --~E~rE-~-~~---
CUST,QNiER:: ROBERT DAUGHERTY
~''~ ~ PO BOX 1364 JUL 26 2004
CLIFTON,CO 81520
Division of Mineralsend Geology
LIFE QTY I DESCRIPTION y REMARKS PURICE TOTAL
:MINERAL MATERIALS / PD -
i,MINERAL MATERIAL °-'' -o'
$1500.OODOWNPAYMENT ''' ~--=~"
1 100.00 PERMIT /STONE -TONS (7S0) - n/a - sli500:00
100 TONS @ $15.00/TON ;~ :;..,;.-.,
~;';: ~..
CASES: COC 065720/$1500.00 ~;;
------- -
_ _-- -_______-_-- - --- TOTAL: ~-•~~$-:-^~ ~.'~~
~54_ ~a~~..,~..,-.
',~;;` „ , ` rt: i~AYIv1EN+I'i~INFO
___ ~ -~
I ~OUNT:r1,500.00 i
TYPE: CHECK
:CHECK~.N©` 1775
NAME: DAUGHERTY, ROBERT
' '}''- ~ PO BOX 1364
;.6<w$.~:%'_; CLIFTON CO 81520
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This receipt was venerated by the automated BLM Collections and Billing System and is a paper representation of a portion
of [hz official elec[ronic record contained therein.
10/29/2003
10/30/2003
I o(I IU/30/031.'_S P~f i