Dor Form 82061-C - Property Tax Form - Small Scale Mines - 2014 Page 4

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SMALL SCALE MINES
CONFIDENTIAL
Company Name_______________________________
For the Year Ended December 31, 2012
HISTORICAL PRODUCTION RECORD
2008
2009
2010
2011
2012
MINE PRODUCTION___________________________________________________________________________ _______________
Tons Underground Ore/Year.|
_____________| _____________| _____________| _____________| _____________|
Tons Open Pit Ore/Year....|
_____________| _____________| _____________| _____________| _____________|
Tons Waste Mined/Year.....|
_____________| _____________| _____________| _____________| _____________|
Total Tons Mined/Year.....|
_____________| _____________| _____________| _____________| _____________|
Ore Grade.................|
_____________| _____________| _____________| _____________| _____________|
Name of Main Product......|
_____________| _____________| _____________| _____________| _____________|
Amount of Main Product....|
|
|
|
|
|
Tons_____Lbs._____Ozs.____|
_____________| _____________| _____________| _____________| _____________|
Name of Other Product.....|
_____________| _____________| _____________| _____________| _____________|
Amount of Other Product...|
|
|
|
|
|
Tons_____Lbs._____Ozs.____|
_____________| _____________| _____________| _____________| _____________|
Average No.- Personnel....|
_____________| _____________| _____________| _____________| _____________|
INCOME SUMMARY- REVENUES & EXPENSES
OPERATING REVENUES IN DOLLARS_____________________________________________________________ _______________
Main Product Revenues.....|
_____________| _____________| _____________| _____________| _____________|
Other Product Revenues....|
_____________| _____________| _____________| _____________| _____________|
GROSS PRODUCT REVENUE.....|
_____________| _____________| _____________| _____________| _____________|
OPERATING COSTS IN DOLLARS________________________________________________________________ _______________
Underground Mining........|
_____________| _____________| _____________| _____________| _____________|
Open Pit Mining...........|
_____________| _____________| _____________| _____________| _____________|
Milling...................|
_____________| _____________| _____________| _____________| _____________|
Leaching..................|
_____________| _____________| _____________| _____________| _____________|
Smelting..................|
_____________| _____________| _____________| _____________| _____________|
Refining..................|
_____________| _____________| _____________| _____________| _____________|
Freight...................|
_____________| _____________| _____________| _____________| _____________|
Royalty...................|
_____________| _____________| _____________| _____________| _____________|
Leased Eqpt. Expense......|
_____________| _____________| _____________| _____________| _____________|
Severance Tax.............|
_____________| _____________| _____________| _____________| _____________|
Property Tax..............|
_____________| _____________| _____________| _____________| _____________|
Administration............|
_____________| _____________| _____________| _____________| _____________|
Overhead..................|
_____________| _____________| _____________| _____________| _____________|
Other Costs...............|
_____________| _____________| _____________| _____________| _____________|
SUBTOTAL OPERATING COST...|
_____________| _____________| _____________| _____________| _____________|
Income Tax................|
_____________| _____________| _____________| _____________| _____________|
( EFFECTIVE INCOME TAX RATE
__________
)
TOTAL OPERATING COST......|
_____________| _____________| _____________| _____________| _____________|
CAPITAL COSTS IN DOLLARS__________________________________________________________________ _______________
Environmental Expense.....|
_____________| _____________| _____________| _____________| _____________|
Replacement Expense.......|
_____________| _____________| _____________| _____________| _____________|
TOTAL CAPITAL COST........|
_____________| _____________| _____________| _____________| _____________|
SUM OPER.& CAPITAL COST...|
_____________| _____________| _____________| _____________| _____________|
PROFIT FROM OPERATIONS IN DOLLARS_________________________________________________________ _______________
Net-Revenues Less Costs...|
_____________| _____________| _____________| _____________| _____________|
DETAIL OF INTEREST AND DEPRECIATION EXPENSES INCLUDED IN OPERATING COSTS__________________ _______________
Interest Expense..........|
_____________| _____________| _____________| _____________| _____________|
Depreciation Expense......|
_____________| _____________| _____________| _____________| _____________|
DOR Form 82061-C (Rev. 11-12)
PAGE A4 OF A12

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