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Division of Reclamation, Mining, and Safety <br />Fee Receipt for Minerals <br />000000000 <br />4184 14300-01 1 Minerals Annual Fees <br />M- 2006 -031, PAID BY SAMUEL SMITH <br />Receipt #: <br />Date: <br />Permit: <br />15211 <br />05/14/2013 <br />Minerals <br />$259.00 <br />Receipt Total: 1 $259.00 <br />Page 1 of 1 <br />