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Mathias Concrete, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1980201 <br />Receipt #: 11668 <br />Date: 10/24/2011 <br />Permit: M1980201 <br />Payment Method Revenue Code Fee Description /Notes <br />Amount <br />11174 -mr1 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1980 -201 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />