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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001019 <br />Bent County <br />Receipt #: <br />Date: <br />5758 <br />06/03/2009 <br />M2001019 <br />Permit <br />000000000 <br />018594 14300-01 1 Minerals Annual Fees <br />M-2001-019 <br />$791.00 <br />Receipt Total: $791.00 <br />Page 1 of 1