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Kiowa County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1991078 <br />Receipt #: 12327 <br />Date: 02/16/2012 <br />Permit: M1991078 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />078339 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1991 -078 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />