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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2000110 <br />01 <br />Mario Bassi and Josephine Bassi <br />Receipt #: <br />Date: <br />Permit: <br />3894 <br />09/05/2008 <br />M2000110 <br />000000000 <br />2167 14300-01 1 Minerals Annual Fees <br />M-2000-110, fees paid by Mario or Josephine Bassi <br />$791.00 <br />Receipt Total: $791.00 <br />Page 1 of 1