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Bent County <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M2001019 <br />Receipt #: 15333 <br />Date: 06/04/2013 <br />Permit: M2001019 <br />Method Payment <br />Revenue Code <br />25388 <br />4300 -01 <br />Minerals Annual Fees <br />M- 2001 -019 <br />$791.00 <br />Receipt Total: <br />$791.00 <br />Page 1 of 1 <br />