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000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2012027 <br />Receipt #: 13477 <br />Date: 08/08/2012 <br />Permit: M2012027 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />2009 <br />4300 -02 <br />Minerals Application Fees <br />M- 2012 -027, CMB <br />$2,696.00 <br />Receipt Total: I $2,696.00 <br />Page 1 of 1 <br />