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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004025 <br />Receipt #: <br />Date: <br />10361 <br />Farnsworth Construction and Gravel Compan <br />Permit: <br />000000000 <br />9833-mr1 14300-01 1 Minerals Annual Fees <br />M-2004-025 <br />04/14/2011 <br />M2004025 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1