Form Smi1 - Severed Mineral Interest Return

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SMI1
Severed Mineral Interest Return
You must file this return semi-annually. Returns are due on July 30 for collections made January through June and
on January 30 for collections made July through December .
County
Minnesota tax ID
Contact person
Phone
For the period (check one):
Year
January 1 to June 30 (due July 30)
July 1 to December 31 (due January 30)
1 Total severed mineral interest collected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Multiply line 1 by 20% ( .20) . PAY THIS AMOUNT as the state’s share of the tax due . . . . . . 2
I declare that this return is correct and complete to the best of my knowledge and belief.
Signature
Position
Date
Mail check payment and return to Minnesota Revenue, Mail Station 3331, St . Paul, MN 55146-3331
.
Phone: 651-556-4721 (TTY: Call 711 for Minnesota Relay)
(Rev . 12/11)

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