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Montrose County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1992017 <br />Receipt #: 12641 <br />Date: 04/04/2012 <br />Permit: M1992017 <br />Amount <br />Payment 'Method Revenue Code Fee Description /Notes <br />00367550 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1992 -017 <br />Receipt Total: 1 <br />$791.00 <br />$791.00 I <br />Page 1 of 1 <br />