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Payment Method <br />Revenue Code <br />Fee Description /Notes <br />Amount <br />104093 <br />4300 -01 <br />Minerals Annual Fees <br />M- 1977 -322, CMB <br />$323.00 <br />Receipt Total: I $323.00 <br />Summit Brick & Tile Co. <br />000000000 <br />Division of Reclamation, Mining, and Safety <br />Fee Receipt for M1977322 <br />Receipt #: 14633 <br />Date: 02/14/2013 <br />Permit: M1977322 <br />Page 1 of 1 <br />