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000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1976059 <br />Receipt #: 13456 <br />Date: 08/06/2012 <br />Permit: M1976059 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />28466 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1976 -059, CMB <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />