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Colorado Moss Rock, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2011039 <br />Receipt #: 11925 <br />Date: 12/13/2011 <br />Permit: M2011039 <br />Payment Method Revenue Code <br />Fee Description /Notes <br />Amount <br />2942 <br />4300 -02 <br />Minerals Application Fees <br />M- 2011 -039, Paid By Kim W. Barickman/Kimberley J. <br />Barickman <br />$1,258.00 <br />Receipt Total: I $1,258.00 <br />Page 1 of 1 <br />