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Washington County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001012 <br />Receipt #: 12977 <br />Date: 05/24/2012 <br />Permit: M2001012 <br />A i <br />Payment hod Revenue Code Fee Description/Notes <br />ount <br />61632 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2001 -012, CMB <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />