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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004057 <br />Receipt #: <br />Date: <br />7393 <br />Bent County <br />Permit: <br />000000000 <br />19761 14300-01 Minerals Annual Fees <br />M-2004-057 <br />01/21/2010 <br />M2004057 <br />$791.00 <br />Receipt Total: $791.00 <br />Page 1 of 1