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Greg Lewicki and Associates <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2012050 <br />Receipt #: 14249 <br />Date: 12/13/2012 <br />Permit: M2012050 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />5314 <br />4300 -02 <br />Minerals Application Fees <br />M- 2012 -050, cmb <br />$2,696.00 <br />Receipt Total: 1 $2,696.00 <br />Page 1 of 1 <br />