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Costilla County <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1994103 <br />Receipt #: 15691 <br />Date: 07/29/2013 <br />Permit: M1994103 <br />Method Payment <br />Revenue Code <br />8678 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1994 -103, CMB <br />$323.00 <br />Receipt Total: <br />$323.00 <br />Page 1 of 1 <br />