Form Spt-901 - Precious Metals Tax Annual Return - 2010 Page 4

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10. The actual cost of development work (in the present taxable year) in or about the mineral producing facility,
such as: engineering and geological; road maintenance; night watchman; machinery and equipment maintenance
repairs;
_____________________
$ __________________
_____________________
$ __________________
_____________________
$ __________________
_____________________
$ __________________
_____________________
$ __________________
_____________________
$ __________________
0.00
TOTAL
$ __________________
Under penalties of perjury, I declare that the foregoing is a full and true statement of the amount and value of the
minerals extracted during the period indicated; that the deductions from said gross yield are the actual costs and none
other, and to the best of my knowledge, it is true, correct and complete.
________________________________________
Signature of taxpayer or if corporate taxpayer,
signature of officer authorized to sign for said corporation
_________________________________________
Date
_________________________________________
Name of Company
Mail to:
SD Department of Revenue
Special Taxes Division
445 East Capitol Avenue
Pierre, SD 57501
1.
PRINT FOR MAILING
CLEAR FORM

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