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Siloam Stone, Inc. <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1997094 <br />[�I�AId�I�I�AIi] <br />Receipt #: 18563 <br />Date: 11/19/2014 <br />Permit: M1997094 <br />Method Payment <br />Revenue Code <br />12246 msr <br />4300 -MAFO <br />Minerals Annual Fees <br />M1997 -094 <br />$323.00 <br />Receipt Total: <br />$323.00 <br />Page 1 of 1 <br />