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Evan L. Melby, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1999073 <br />Receipt #: 14576 <br />Date: 02/08/2013 <br />Permit: M1999073 <br />Payment Method Revenue Code Fee Description /Notes <br />Amount <br />11809 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1999 -073, CMB <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />