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Wallace F. Burtis <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001070 <br />Receipt #: 13544 <br />Date: 08/20/2012 <br />Permit: M2001070 <br />Payment Method Revenue Code Fee Descnption/Notes Aroun <br />8406 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2001 -070 <br />$259.00 <br />Receipt Total: I $259.00 <br />Page 1 of 1 <br />