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Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1991003 <br />General Shale Brick <br />Receipt #: <br />Date: <br />Permit: <br />000000000 <br />569057 <br />4300-01 <br />Minerals Annual Fees <br />M-1991-003 <br />5324 <br />04/08/2009 <br />M1991003 <br />$791.00 <br />Receipt Total: $791.00 <br />Page 1 of 1