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Seifert Construction <br />000000000 <br />28929 <br />4300 -01 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1999003 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />Minerals Annual Fees <br />M- 1999 -003, CMB <br />Receipt Total: <br />Receipt #: 12568 <br />Date: 03/23/2012 <br />Permit: M1999003 <br />$323.00 <br />$323.00 <br />Page 1 of 1 <br />