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City & County of Denver acting by & thru Bd c <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004078 <br />Receipt #: 13899 <br />Date: 10/12/2012 <br />Permit: M2004078 <br />Payment Method Revenue Code <br />Fee Description /Notes <br />Ar <br />ount <br />00323726 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2004 -078, CMB <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />