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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1991073 <br />Receipt #: <br />Date: <br />Permit: <br />10776 <br />06/16/2011 <br />M1991073 <br />Kiowa County <br />000000000 <br />75743 14300-01 1 Minerals Annual Fees <br />M-1991-073 <br />$323.00 <br />Receipt Total: $323.00 <br />Page 1 of 1