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San Miguel County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1981154 <br />Receipt #: 11661 <br />Date: 10/24/2011 <br />Permit: M1981154 <br />Payment Method Revenue Code <br />Fee Description /Notes <br />1'm0_u <br />068129 -mr1 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1981 -154 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />