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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2009093 <br />Theisen Mineral <br />2166 14300-02 1 Minerals Application Fees <br />M- 2009 -093, Paid By Alan Lyle Banta /Janice H. Banta <br />Receipt #: 7178 <br />Date: 12/21/2009 <br />Permit: M2009093 <br />$1,258.00 <br />Receipt Total: 1 $1,258.00 <br />Page 1 of 1 <br />