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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1979045 <br />The Lakewood Brick and Tile Company <br />000000000 <br />110978 msr 14300-01 1 Minerals Annual Fees <br />M1979 -045 paid by Summit Brick Company <br />Receipt #: <br />Date: <br />Permit: <br />16914 <br />02/24/2014 <br />M1979045 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />