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Farnsworth Construction and Gravel Compan <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2004025 <br />Receipt #: 15049 <br />Date: 04/22/2013 <br />Permit: M2004025 <br />Payment Method Revenue Code <br />Fee Description /Notes <br />Amount <br />11089 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 2004 -025 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />