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Kirby Quint <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2003002 <br />4995 14300-01 1 Minerals Annual Fees <br />M- 2003 -002, CMB <br />Receipt #: <br />Date: <br />Permit: <br />13516 <br />08/14/2012 <br />M2003002 <br />$323.00 <br />Receipt Total: 1 $323.00 <br />Page 1 of 1 <br />