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Universal Landscape & Aggregate Supply, Inc <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004043 <br />Receipt #: 12824 <br />Date: 04/30/2012 <br />Permit: M2004043 <br />[Payment Method [Revenue Code 4 Fee Description /Notes <br />Amount <br /> <br />4300 -09 <br />Minerals Succession of Operators <br />M- 2004 -043 <br />$144.00 <br />Receipt Total: I $144.00 <br />Page 1 of 1 <br />