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Williams Fork Mining Company <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1984168 <br />Receipt #: 11656 <br />Date: 10/21/2011 <br />Permit: M1984168 <br />Payment Method Revenue Code Fee Description /Notes. Amount <br />045243 -m r1 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1984 -168 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />