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Glenn Southwick <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1986007 <br />Receipt #: 14719 <br />Date: 03/01/2013 <br />Permit: M1986007 <br />Payment Method Revenue Code Fee Description /Notes <br />Amount <br />1300 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1986 -007 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />