Form Mmg - Statement Of Gross Proceeds Of Metal Mines

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MONTANA
MMG
Rev. 12-07
Statement of Gross Proceeds of Metal Mines
For year ending December 31, _______
Title 15, Chapter 23, Part 8, MCA
Name:
Address:
Address:
City:
State:
Zip Code:
1. FEIN:
2. Account ID:
3. Period:
4. If this is an amended return, check here.
,
5. If you are no longer in business and want your account cancelled, check this box
enter the fi nal date. __________
6. If your mailing address has changed, check this box
and print new address below:
____________________________________________________________________
____________________________________________________________________
Name of Mine:
Smelter Name:
County:
Address:
Section:
Township:
Range:
City:
School District:
State:
Zip:
Type of Mineral
Quantity in Ounces Gross Value of Mineral
7. Copper ................................................................................................7.
oz $
8. Gold ....................................................................................................8.
oz $
9. Lead....................................................................................................9.
oz $
10. Molybdenum .....................................................................................10.
oz $
11. Nickel ................................................................................................ 11.
oz $
12. Palladium ..........................................................................................12.
oz $
13. Platinum............................................................................................13.
oz $
14. Silver.................................................................................................14.
oz $
15. Zinc ...................................................................................................15.
oz $
16. Rhodium ...........................................................................................16.
oz $
17. Other.................................................................................................17.
oz $
18. Total Gross Value (add lines 7 through 17) ........................................................................ 18. $
Deductions:
19. Less: Treatment and Refi ning Charges .............................................................................. 19. ($
)
20. Less: Transportation from Mine to Smelter......................................................................... 20. ($
)
21. Merchantable Value (line 18 minus lines 19 and 20) .......................................................... 21. $
22. Total Tons of Ore Extracted During Year ..........................................22.
Returns are due on March 31st of the following year. Penalties and Interest apply on all delinquent reports pursuant to
15-23-104, MCA.
I hereby swear or affi rm under penalty of perjury that the statements contained herein are true to the best of my
knowledge.
Signature ___________________________________________
Title _______________________________________________ Phone __________________ Date ________________
Mail this return to:
Department of Revenue, PO Box 5805, Helena MT 59604-5805

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