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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1980112 <br />Rio Blanco County <br />000000000 <br />Receipt #: <br />Date: <br />Permit: <br />15589 <br />07/12/2013 <br />M1980112 <br />Method Payment <br />Revenue Code <br />138560 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1980 -112, CMB <br />$791.00 <br />Receipt Total: <br />$791.00 <br />Page 1 of 1 <br />