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Washington County Dist #3 <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1997015 <br />Receipt #: 11946 <br />Date: 12/15/2011 <br />Permit: M1997015 <br />Payment Method <br />Revenue Code u': <br />Fee Descr ption /Notes` t Amount <br />60238 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1997 -015 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />