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Division of Reclamation, Mining, and Safety <br />Fee Receipt for Minerals <br />Angela Bellantoni <br />Receipt #: <br />Date: <br />7270 <br />Permit: <br />000000000 <br />Visa 14400 1 Mineral Copies <br />M-2004-028 <br />01/06/2010 <br />Minerals <br />$5.00 <br />Receipt Total: 1 $5.00 <br />Page 1 of 1