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Jack Pine Mining Company <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1990147 <br />Receipt #: 14587 <br />Date: 02/08/2013 <br />Permit: M1990147 <br />Payment Method Revenue Code <br />A i <br />Fee Description /Notes <br />ount <br />5205 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1990 -147, CMB <br />$259.00 <br />Receipt Total: I $259.00 <br />Page 1 of 1 <br />