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General Shale Brick, Inc. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977252 <br />Receipt #: 14351 <br />Date: 01/04/2013 <br />Permit: M1977252 <br />Payment Method <br />Revenue Code <br />Fee De cription /Notes <br />Amount <br />809618 jwd <br />4300 -01 <br />Minerals Annual Fees <br />M- 1977 -252 <br />$791.00 <br />Receipt Total: I $791.00 <br />Page 1 of 1 <br />