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Allen Drilling and Excavating <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2005080 <br />Receipt #: 13852 <br />Date: 10/09/2012 <br />Permit: M2005080 <br />Paymen Nt hod Revenue Code <br />Fee Description/Notes <br />Amount <br />6184 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2005 -080, CMB <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />