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Mario Bassi and Josephine Bassi <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2000110 <br />Receipt #: 11419 <br />Date: 09/19/2011 <br />Permit: M2000110 <br />Payment Method Revenue Code <br />Fee Description/Notes r` <br />Amount <br />2818 -mr1 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2000 -110 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />