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000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for Minerals <br />Receipt #: 13723 <br />Date: 09/20/2012 <br />Permit: Minerals <br />Payment Method Revenue Code <br />e Description /No' <br />Amount <br />3348 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1974 -092, CMB <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />