Fillable Form 04-661 Mining License Application printable pdf download

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Alaska Department of Revenue - Tax Division

DEPT USE ONLY

STATE OF ALASKA

550 West 7

Ave Ste 500

Year

License Number

Anchorage AK 99501-3566

MINING

LICENSE APPLICATION

907-269-6620

Date Issued

AS 43.65.010.060

Tax_Mining@alaska.gov

(For all mining activities, including sand and gravel)

One Application Per Location

This Application Is

For License Year

The Business or Company is

New

Sole Proprietorship

Corporation

Renewal

SSN:_____________________

EIN:______________________

Applicant Name (First, Middle Initial, Last)

Partnership

Joint Venture

EIN:______________________

Business or Company Name

Business Phone Number

Date Business Began

Business Mailing Address

City

State

Zip + 4

Property Location

Recording District

Company name(s), if any, under which previous mining operations have been conducted:

Mineral or Material Mined (check all boxes that apply for this location).

Coal

Copper

Gold

Silver

Zinc

Tin

Lead

Peat

Topsoil

Rock

Sand & Gravel

Platinum

Other (Please List) ______________________________

ATTENTION LEASE HOLDERS:

If you hold the lease on this claim, please provide the following information:

Claim Owner Name

Phone Number

Mailing Address

City

State

Zip + 4

Who Must Have A Mining License? See 15 AAC 65.010

The following persons are not in the business of mining and are not

A person engaged in one or more of the following activities in the

required to obtain a mining license:

state is in the business of mining and shall obtain a mining license:

(See 15AAC 65.020(b) for exceptions).

(1) a person whose mining activities are restricted to the holding of

property for exploration to locate and delineate mineral deposits or

(1) a person owning and operating a mining property;

for future development;

(2) a person owning a mining property and receiving lease or

(2) a person who holds mineral interests described in (a)(4) of this

royalty payments based on production from the property;

section in undeveloped and non-producing properties;

(3) a person whose sole mining activity in the state consists of

(3) a person leasing a mining property from another person and

extracting sand, gravel, rock, or fill material from federal, state, or

operating the property;

municipal land, if the material is to be used exclusively by that

(4) a person possessing a mineral interest, whether an

person for public construction projects or for personal use, and is

economic or a production interest, in a producing property,

not held for resale.

including royalty, working or operating interests, net profits,

A mining license must be obtained for each mining operation

overriding royalties, carried interests, and production payments;

conducted in this state. A person owning several mining properties that

(5) a person who is temporarily exempt from taxation under AS

constitute a single mining operation may apply for one license.

43.65.010(a). Note: this exemption does not apply to sand and

Under AS 43.65.030, application for renewal of a mining license shall

gravel mining operations.

be made before May 1 of each year.

I declare under penalty of unsworn falsification that this application and accompanying sketch has been examined by me, and to the best of my knowledge

and belief is true, correct and complete.

Applicant Signature

Title

Date

IMPORTANT: COMPLETE THE REQUIRED SKETCH OF THE EXACT LOCATION OF YOUR OPERATION ON PAGE 2 OF THIS APPLICATION.

04-661 webform (Rev 02/07)

Form 04-661 Mining License Application

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