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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004038 <br />Receipt #: <br />Date: <br />Permit: <br />9629 <br />01/03/2011 <br />M2004038 <br />Rio Blanco County <br />000000000 <br />131737-mr1 14300-01 <br />Minerals Annual Fees $323.00 <br />M-2004-038 <br />Receipt Total: $323.00 <br />Page 1 of 1