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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001019 <br />Receipt #: <br />Date: <br />Permit: <br />10564 <br />05/16/2011 <br />M2001019 <br />Bent County <br />000000000 <br />22061 4300-01 Minerals Annual Fees <br />M-2001-019 <br />$791.00 <br />Receipt Total: $791.00 <br />Page 1 of 1