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Breeze Basin Resources <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2011017 <br />Receipt #: 12785 <br />Date: 04/25/2012 <br />Permit: M2011017 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />1042 jwd <br />4300 -11 <br />Minerals Technical Revision <br />M- 2011 -017 <br />$216.00 <br />Receipt Total: I $216.00 <br />Page 1 of 1 <br />