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Mine Development Inc <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1981165 <br />Receipt #: 13841 <br />Date: 10/04/2012 <br />Permit: M1981165 <br />Payment Method ' Revenue Code <br />� escri son /Notes Amount <br />1025 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1981 -165, Paid By Harold E Luzar Jr/ Robbin G Luzar <br />$259.00 <br />Receipt Total: I $259.00 <br />Page 1 of 1 <br />