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Rivera's Excavation <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004053 <br />Receipt #: 14310 <br />Date: 12/21/2012 <br />Permit: M2004053 <br />P aymen t 14 <br />od : Revenue Code <br />Fee Description /Notes Amount <br />6511 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2004 -053, Paid By Eleuto J. Rivera /Rita Rivera <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />