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Tracy and Ed Grimes <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2009077 <br />Receipt #: 13930 <br />Date: 10/15/2012 <br />Permit: M2009077 <br />Payment Method Revenue Code Fee De <br />C <br />iption /Notes <br />Amoun <br />1242 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2009 -077, CMB <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />