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Moffat County <br />1 <br />000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1980239 V <br />Receipt #: 11855 <br />Date: 7 11/28/2011 <br />Permit: M1980239 <br />Payment Method Revenue Code Fee Description /Notes Amount <br />322133 -m r1 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1980 -239 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />