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Jack Clark Jr. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2005065 <br />Receipt #: 14161 <br />Date: 11/26/2012 <br />Permit: M2005065 <br />Payment Method Revenue Code <br />Fee Description/Notes Amount <br />1558 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2005 -065, Paid By Upper Animas Rock Products L.L.P. <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />