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Division of Reclamation, Mining, and Safety <br /> Fee Receipt for M1991147 <br /> Belvedere Stone, LLC RECEIVED Receipt#: 21705 <br /> William Johannsen Date: 06/23/2016 <br /> c/o Ms. Ginny Kenley JUN 3 ? ; <br /> Permit: M1991147 <br /> 2635 Steel Dr OF RECLAMATION, <br /> Colorado Springs CO 809070000 FEE x R' RALS <br /> MethodPayment Revenue Code Fee Descripdon/Notes Amount <br /> Check#1022 4300-MAFO Minerals Annual Fees $323.00 <br /> *2015's Annual Fee only(Report/Map not rec'd) <br /> Receipt Total: $323.00 <br /> Page 1 of 1 <br />