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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001070 <br />Wallace F. Burtis <br />Receipt #: <br />Date: <br />Permit: <br />6362 <br />08/13/2009 <br />M2001070 <br />000000000 <br />7931 1 4300-01 1 Minerals Annual Fees <br />M-2001-070, Paid By Wallace F. or Joanne Burtis <br />$259.00 <br />Receipt Total: 1 $259.00 <br />Page 1 of 1