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CEMEX, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977361 '� <br />Receipt #: 13891 <br />'bate: <br />10/11/2012 <br />Permit: M1977361 <br />Payment Method Revenue Code <br />Fee Description /Notes <br />A t <br />ount <br />22469768 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1977 -361 <br />$323.00 <br />Receipt Total: I $323.00 <br />Page 1 of 1 <br />