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General Shale Brick, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1981148 <br />Receipt #: 14062 <br />Date: 11/07/2012 <br />Permit: M1981148 <br />Payment Method Revenue Code <br />Fee Description /Notes Amount <br />802355 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1981 -148 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />