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Bent County <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1983177 <br />Payment Method Revenue Code <br />F+ <br />A i <br />e Description /Notes <br />ount <br />jwd <br />4300 -11 <br />Minerals Technical Revision <br />M- 1983 -177 <br />$216.00 <br />Receipt Total: 1 $216.00 <br />,2(v/f-037 <br />Receipt #: 14924 <br />Date: 04/03/2013 <br />Permit: M1983177 <br />Page 1 of 1 <br />