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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2005065 <br />Jack Clark Jr. <br />Receipt#: 1926 <br />Date: 11/09/2007 <br />Permit: M2005065 <br />000000000 <br />3615 14300-01 I Minerals Annual Fees I $323.00 <br />M-2005-065 <br />Receipt Total: ~ $323.00 <br />Page 1 of 1 <br />