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T Bone Stone, Inc. <br />000000000 <br />Division of Reclamation,tining, and Safety <br />Fee Receipt for1V12004030 <br />(11 <br />Receip : 13919 <br />4- 6ate: 10/15/2012 <br />Permit: M2004030 <br />ayment Method Revenue Code <br />Fr <br />DescriptioNNotes <br />fi cunt <br />4263 jwd <br />5700 <br />Minerals Civil PenaltyNiolation Fines f <br />M- 2004 -030, MV- 2012 -023 <br />$500.00 <br />Receipt Total: I $500.00 <br />Page 1 of 1 <br />