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Fremont County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1984117 <br />Receipt #: 14357 <br />Date: 01/07/2013 <br />Permit: M1984117 <br />ent Me <br />Pay <br />hod Revenue Code <br />Fee Description /Notes <br />A i <br />oun <br />103701 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1984 -117, CMB <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />