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Clear Creek District Water Providers, L.L.C. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004067 <br />Receipt #: 12637 <br />Date: 04/03/2012 <br />Permit: M2004067 <br />r Payment Method Revenue Code <br />Fee Description / Notes Amount <br />2266 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2004 -067, Paid By Bromley District Water Providers <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />