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Mario Bassi and Josephine Bassi <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2000110 <br />Receipt #: 13663 <br />Date: 09/07/2012 <br />Permit: M2000110 <br />Payment Method Revenue Code <br />Fee Deseript on /Notes= Amount <br />3051 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2000 -110 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />