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Division of Reclamation, Mining, and Safety <br />Fee Receipt for Minerals <br />Black Range Minerals <br />Ben Vallerine <br />P.O. Box 18041 <br />Golden CO 804020000 <br />Receipt #: <br />Date: <br />Permit: <br />2016 <br />11 /27/2007 <br />Minerals <br />Cash 14400 I Mineral Copies <br />M-2007-044 <br />$5.00 <br />Receipt Total: $5.00 <br />Page 1 of 1 <br />