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Centennial State Paving, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2007069 <br />Receipt #: 13374 <br />Date: 07/24/2012 <br />Permit: M2007069 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />1642 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2007 -069, Paid By Indian Hills, LLC/ Charles H Bedard, <br />Manager <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />