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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004021 <br />Washington County <br />Receipt #: <br />1303 <br />08/21/2007 <br />Date: <br />Permit: <br />000000000 <br />M2004021 <br /> <br />027756 4300-01 Minerals Annual Fees <br />M-2004-021, Balance Due $103.00 <br /> <br />Receipt Total: ~ $103.00 <br />Page 1 of 1 <br />