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Washington County Dist #2 <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1997015 <br />Receipt #: 14152 <br />Date: 11/23/2012 <br />Permit: M1997015 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />63178 jwd <br />4300 -03 <br />Minerals Amendment Fees <br />M- 1997 -015 <br />$2,229.00 <br />Receipt Total: $2,229.00 <br />Page 1 of 1 <br />