Form Spt-901 - Precious Metals Tax Annual Return - 2010 Page 3

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5. The cost of maintenance and repairs of all general administrative building, facilities and equipment and all
general administrative expenses incurred in connection with mining or extracting and milling or refining
operations in the State of South Dakota.
General & Administrative Expense
$ __________________
Audit Expense
$ __________________
Utilities
$ __________________
Royalties
$ __________________
_____________________
$ __________________
_____________________
$ __________________
_____________________
$ __________________
_____________________
$ __________________
_____________________
$ __________________
0.00
TOTAL
$ __________________
6. All interest cost and all insurance costs paid or accrued on the machinery, equipment, apparatus, works, plants
and facilities.
Insurance
$ __________________
_____________________
$ __________________
_____________________
$ __________________
0.00
TOTAL
$ __________________
7. State and local taxes paid.
Real and Personal Property
$ __________________
Licenses
$ __________________
Miscellaneous Taxes
$ __________________
Gross Severance Taxes
$ __________________
____________________
$ __________________
TOTAL
$ __________________
0.00
8. Depreciation at the same rates allowable for Federal Income tax purposes.
DEPRECIATION
$ __________________
9. All moneys expended for premiums for industrial insurance and the actual cost of hospital and medical
attention, and accident benefits and group insurance for all employees. Also all moneys paid as contributions
under the Federal "Social Security Act", and all moneys paid to either the State of South Dakota or the Federal
Government under any amendment to either or both of the statutes above mentioned.
Industrial Insurance
$ __________________
Unemployment Insurance
$ __________________
Social Security
$ __________________
Pension or Retirement Fund
$ __________________
Profit Sharing
$ __________________
Group Health and Accident Insurance
$ __________________
Worker's Compensation Insurance
$ __________________
Other (attach schedule)
$ __________________
0.00
TOTAL
$ __________________

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