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Montrose County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1984152 <br />Receipt #: 13601 <br />Date: 08/29/2012 <br />Permit: M1984152 <br />Payment Method Revenue Code <br />ee Description/Notes <br />A <br />n <br />00370093 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1984 -152 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />