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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1999069 <br />Receipt #: <br />Date: <br />4566 <br />Jake Kauffman & Son, Inc <br />Permit: <br />000000000 <br />65183 14300-01 1 Minerals Annual Fees <br />M-1999-069 <br />12/29/2008 <br />M1999069 <br />$791.00 <br />Receipt Total: $791.00 <br />Page 1 of 1