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John R. Kurtzer <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2002053 <br />Receipt #: 14201 <br />Date: 12/03/2012 <br />Permit: M2002053 <br />Payment Method Revenue Code Fee Description /Notes <br />Amount <br />11837 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2002 -053, CMB <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />