Form Mt11 - 2003 Taconite Production Report - Minnesota Department Of Revenue Page 4
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4MT11
2003 Taconite Production Report
Company name
Part 4—Credit for Chips and Fines Sold
A. Acid pellet chips and fines
Tonnage sold (dry less flux)*
Sold to
Address
City
State
Zip code
B. Flux pellet chips and fines
Tonnage sold (dry less flux)*
Sold to
Address
City
State
Zip code
C. Fine concentrates
Tonnage sold (dry less flux)*
Sold to
Address
City
State
Zip code
*
Tons sold during the calendar year covered by the production tax report. Some material sold could have been produced and taxed in earlier years.
I declare that this report is correct and complete to the best of my knowledge and belief.
Signature of officer
Title
Date
Daytime phone
(
)
Signature of preparer
Minnesota tax ID, SSN or PTIN
Date
Daytime phone
(
)
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Minnesota Revenue, 612 Pierce St., Eveleth, MN 55734. Phone: 218-744-7420 TTY: 711 Minnesota Relay
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