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Phillips County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1990116 <br />Receipt #: 13744 <br />Date: 09/20/2012 <br />Permit: M1990116 <br />Payment I <br />thod r Revenue Code <br />e Description!Notee Amoun <br />26786 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1990 -116 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />