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Cottonwood Land and Farms, LLC <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1979097 <br />Receipt #: 14464 <br />Date: 01/17/2013 <br />Permit: M1979097 <br />Pa ment Method Revenue Cod Fee Description/Notes Amount <br />4687 jwd <br />4300 -09 <br />Minerals Succession of Operators <br />M- 1979 -097, Paid By Michael J. Hart dba Hart Environmental • <br />$144.00 <br />Receipt Total: I $144.00 <br />Page 1 of 1 <br />