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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001070 <br />Wallace F. Burtis <br />000000000 <br />8084 4300-01 Minerals Annual Fees <br />M-2001-070 <br />Receipt #: <br />Date: <br />Permit: <br />8762 <br />08/06/2010 <br />M2001070 <br />$259.00 <br />Receipt Total: $259.00 <br />Page 1 of 1