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Shane Cooper dba Dirt Guys LLC <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for ii1994092 <br />Receipt #: 14515 <br />2,4ate: 01/28/2013 <br />Permit: M1994092 <br />Payment Method Revenue Code Fee Description /Notes Amount <br />2182 jwd <br />4300 -01 <br />Minerals Annual Fees 1/ <br />M- 1994 -092 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />