Form Sr-89 - Sand Royalty Monthly Reporting Form - Kansas Department Of Revenue
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1STATE OF KANSAS
DEPARTMENT OF REVENUE
Customer Relations
Kansas Department of Revenue
Phone: (785) 296-3500
915 SW Harrison St.
Fax: (785) 296-4993
Topeka, KS 66625-8100
Hearing Impaired TTY: (785) 296-6461
Division of Taxation
SAND ROYALTY
Monthly Reporting Form
(Company)
(Address)
Report Month
(City, State, Zip Code)
(A)
(B)
(C)
(D)
(E)
Total Tons
River, Drainage District
Removed and
Tons Sold
Royalties Due
Permit #
County and Legal Description
Not Returned
Outside Kansas
(C) x $.15
A cubic yard of sand or material is equal to 2,700 pounds.
TOTAL ROYALTIES DUE
By terms of the contract previously entered into with the Director of Taxation, it is certified that the above is a true and correct report
of all river sand removed during the report month.
(Signature)
(Date)
(Title)
SR-89
(Telephone Number)
(Rev. 1/01)
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