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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1983164 <br />George F. Gallegos <br />000000000 <br />5979 1 4300 -01 1 Minerals Annual Fees <br />M- 1983 -164, CMB <br />Receipt #: <br />Date: <br />Permit: <br />13514 <br />08/14/2012 <br />M1983164 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />