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Wilbur F Benham <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1984039 <br />Receipt #: 12816 <br />Date: 04/27/2012 <br />Permit: M1984039 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />4328 <br />4300 -02 <br />Minerals Application Fees <br />M- 1984 -039, CMB <br />$259.00 <br />Receipt Total: I $259.00 I <br />Page 1 of 1 <br />