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Baca County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977479 <br />Receipt #: 13606 <br />Date: 08/30/2012 <br />Permit: M1977479 <br />Revenue Cole <br />Palm) <br />IQniNote <br />e au <br />106084 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1977 -479 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />