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General Shale Brick, Inc. <br />Division of Reclamation, Mining, and Safety <br />11IITII1 <br />Fee Receipt for M1991003 <br />00857010 SMS 1 4300 -01 1 Minerals Annual Fees <br />M1991-003 <br />Receipt #: 17261 <br />Date: 04/22/2014 <br />Permit: M1991003 <br />$791.00 <br />Receipt Total: 1 $791.00 <br />Page 1 of 1 <br />