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City of Golden <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977534 <br />Receipt #: 14534 <br />Date: 01/29/2013 <br />Permit: M1977534 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />576633 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1977 -534, CMB <br />$791.00 <br />Receipt Total: I $791.00 1 <br />Page 1 of 1 <br />