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City of Monte Vista <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1992060 <br />Receipt #: 13976 <br />Date: 10/23/2012 <br />Permit: M1992060 <br />Payment Method Revenue Code <br />fee, Description /Notes <br />unt <br />20258 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1992 -060 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />