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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004052 <br />Phillips County <br />Receipt #: <br />Date: <br />Permit: <br />8817 <br />08/17/2010 <br />M2004052 <br />000000000 <br />21157 14300-01 1 Minerals Annual Fees <br />M-2004-052 <br />$323.00 <br />Receipt Total: $323.00 <br />Page 1 of 1