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Division of Reclamation, Mining, and Safety <br />Fee Receipt for Minerals <br />Receipt #: <br />Date: <br />Permit: <br />9667 <br />01/05/2011 <br />Minerals <br />Empress Mining Co <br />Robert Fabrizio <br />1330 South 9th St. <br />Canon City CO 812120000 <br />Cash 4400 Mineral Copies <br />M-2009-076 <br />$5.00 <br />Receipt Total: $5.00 <br />Page 1 of 1