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Baca County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2003019 <br />Receipt #: 11710 <br />Date: 11/03/2011 <br />Permit: M2003019 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />103263 <br />4300 -04 <br />Minerals Conversions <br />M- 2003 -019 <br />$2,696.00 <br />Receipt Total: I $2,696.00 <br />Page 1 of 1 <br />