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Montezuma County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1978107 <br />Receipt #: 14322 <br />Date: 12/24/2012 <br />Permit: M1978107 <br />Payment Method Revenue Code Fee Description /No <br />es <br />Amount <br />00025019 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1978 -107, CMB <br />$791.00 <br />Receipt Total: I $791.00 I <br />Page 1 of 1 <br />