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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1982129 <br />L. Otto Goemmer <br />000000000 <br /> <br />Minerals Annual Fees <br />M-1982-129 (requesting $27.00 refund) <br />Receipt #: <br />Date: <br />Permit: <br />9140 <br />10/05/2010 <br />M1982129 <br />$350.00 <br />Receipt Total: $350.00 <br />Page 1 of 1