Montana Form Mine-Cert - Application And Affidavit For Certification And Approval Of Mineral And Coal Exploration Incentive Credits - 2006 Page 2
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5Applicant Name__________________________________
Part C
Prospect/Mineral Information
1.
To your knowledge, has mining ever occurred on the prospect/mineral property? (Check one box below.)
Yes
No
Unknown
2.
Please describe all existing improvements made or located on prospect/mineral property such as mine cuts, camps,
wash plants, mill facilities, airstrips, roads, etc. Attach additional sheets if necessary.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
3.
If this application is for a previous mine, please indicate the date that the mine was shut down. (month and year)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
4.
To your knowledge, has an Affidavit of Initial Production ever been filed for this property? (Check one)
Yes
No
Unknown
If you answered yes to this question, go to questions 5 and 6. Otherwise, go to question 7.
5.
Enter the date of initial production as indicated on the affidavit.(month and year) ________
6.
Enter the final date (month and year) that the title and the mineral rights to prospect/mineral property were acquired.
_____________________________________________________________________________________________
Check the boxes below for each land description that applies:
Land where the prospect/mineral property is located is vacant/unappropriated state/federal land.
Land where the prospect/mineral property is located is claimed, leased or patented by applicant.
Land where the prospect/mineral property is located is claimed, leased, patented, or private land to which the
applicant has acquired the mineral/mining rights.
7a.
Do you have all permits that are necessary to commence construction of a mine.
Yes
No
7b.
List all permit numbers, issuing agencies, type of permit, date of any permits, and status of permits issued as of date of
this application below. Include such permits as APMA Plan of Operation Approval, Reclamation Plan Approval, NPDES
401, Solid Waste, Air Quality, Wetlands 404, etc. If you answered “No” to question 7a, please include in the list below
those permits that you have not yet obtained. Attach supplemental sheets, if necessary.
Permit
Number
Issuing Agency Name
Type of Permit
Date of Permit
Status of Permit
_________
__________________
__________________
__________________
__________________
_________
__________________
__________________
__________________
__________________
_________
__________________
__________________
__________________
__________________
_________
__________________
__________________
__________________
__________________
8.
Please provide a description of the minerals that you are seeking by the exploration work claimed.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
9.
Enter the legal description of each of the physical areas included in this credit application. Include all meridians,
townships, ranges and sections.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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