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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2000040 <br />Medicine Bow - Routt National Forest USDA F1 <br />Receipt #: <br />Date: <br />Permit: <br />10586 <br />05/18/2011 <br />M2000040 <br />000000000 <br />1134 14300-01 1 Minerals Annual Fees <br />M-2000-040, Paid By Dawn A Hull/USDAFS <br />$323.00 <br />Receipt Total: $323.00 <br />Page 1 of 1