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Prowers County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977387 <br />Receipt #: 14190 <br />Date: 11/29/2012 <br />Permit: M1977387 <br />Paymen <br />hod Revenue Code <br />Fee Description /Notes <br />Amount <br />44077 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1977 -387 <br />$79t00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />