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Bent County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004057 <br />Receipt #: 14439 <br />Date: 01/14/2013 <br />Permit: M2004057 <br />Payment Method <br />Revenue Code <br />Fee Description /Notes <br />punt <br />24865 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2004 -057, CMB <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />