Dor Form 82061-C - Property Tax Form - Small Scale Mines - 2014 Page 2

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SMALL SCALE MINES
CONFIDENTIAL
Company Name_______________________________
For the Year Ended December 31, 2012
MINING COMPANY PROPRIETARY DATA
Name of Property_____________________________________________________________________
Name of Owner________________________________________________________________________
Name of Operator/Lessee______________________________________________________________
Address of Operator/Lessee___________________________________________________________
Official responsible for this report_________________________________________________
Telephone Number_____________________Email Address___________________________________
Contact person regarding information in this report__________________________________
Telephone Number_____________________Email Address___________________________________
Type of Mine----Underground____Open pit____Leach____In-situ____Other_________________
Principal saleable product___________________________________________________________
Other saleable by-products___________________________________________________________
Date production started______________________________________________________________
Date Production stopped_____________________
Permanent or Temporary_________________
Average weighted sales price per unit received for each product sold calendar year
2012: ________________________________________________________________________________
ORE RESERVE DATA
Mineable Ore Reserves: Ore as of January 1, 2013. Ore reserves should include all owned
or leased ores held by the taxpayer. Show the tons of reserves held under each category
and the ore grade in ozs/ton, % ,lbs/ton or as appropriate on the table below:
Federal
Private
State
Indian
Total Tons Ore
Underground Ore
____________
_____________
_____________
_____________
Open Pit Ore
____________
_____________
_____________
_____________
Ore Grade-Main Product
____________
_____________
_____________
_____________
Name of Metal/Mineral
____________
_____________
_____________
_____________
Ore Grade-Other Product
____________
_____________
_____________
_____________
Name of Metal/Mineral
____________
_____________
_____________
_____________
Waste Tons
____________
_____________
_____________
_____________
Estimated stripping ratio_____________
Estimated mine life in years_______________
DOR Form 82061-C (Rev. 11-12)
PAGE A2 OF A12

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