Form Mine-Cert - Application And Affi Davit For Certifi Cation And Approval Of Mineral And Coal Exploration Incentive Credits Page 2
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7Applicant Name__________________________________
Part III. Prospect/Mineral Information
X
1.
Has mining ever occurred on the prospect/mineral property? (Mark
one box.)
Yes
No
Unknown
If yes, please provide date(s) in which activity commenced, including, but not limited to, when approvals, licenses,
permits, etc. were issued for the mining activity.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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).
Please also provide the date(s) when all previous mining approvals, permits, licenses, etc., were terminated.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
X
4.
Has an Affi davit of Initial Production ever been fi led for this property? (Mark
one box.)
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 affi davit (month and year). ________
6.
Enter the fi nal date (month and year) that the title and the mineral rights to prospect/mineral property were acquired.
___________________________________________________________________________________________
X
Mark
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 permits, date of any permits, and status of permits issued as of
the 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.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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