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Jefferson County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977245 <br />Receipt #: 12173 <br />Date: 01/24/2012 <br />Permit: M1977245 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />570983 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1977 -245 <br />$791 00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />