Form 8111 - Annual Gross Products Attachment For Production By Legal Description Page 2
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1
2State of Wyoming
ANNUAL GROSS PRODUCTS
8111
Department of Revenue
ATTACHMENT FOR
*8111*
122 West 25th Street
PRODUCTION BY LEGAL DESCRIPTION
Cheyenne, WY 82002-0110
Production Year:
__ __ __ __
TAXPAYER INFORMATION
MINE GROUP INFORMATION
Operator ID
Mine Group Number
Revenue Use Only
Taxpayer
Mine Group Name
A separate Form 8111 must be filed for each DEQ Permit Number
related to the production reported for the Mine Group
DEQ PERMIT NUMBER
MINERAL
Total Production for the year, listed by legal description
Section
County
Tax
¼ ¼ or Lot
Township
Range
Units Produced
Dist.
PAGE TOTAL
MTS 2
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Parent category: Financial