Form Mine-Cert - Application And Affidavit For Certification And Approval Of Mineral And Coal Exploration Incentive Credits
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CLEAR FORM
MINE-CERT
Rev 06 13
Application and Affidavit for Certification
and Approval of Mineral and Coal Exploration Incentive Credits
15-32-504, MCA
Application for the year ending December 31, ________
This application must be submitted no later than 60 days after the close of the above-listed calendar year.
Name of Applicant _________________________________________________________________________________
Address of Applicant _______________________________________________________________________________
Project Name (if any) _______________________________________________________________________________
Project Area (for general reference purposes) ___________________________________________________________
Part I. Eligible Costs
Enter the total amount of exploration incentive credit costs from Part IV, Line 9, of this application.
$ _______________
Specific activities for which costs may be taken: You may request an exploration incentive credit for the eligible costs
for each of the mineral and coal exploration activities listed below. These activities must be performed for the purpose
of determining the existence, location, extent or quality of a locatable or leasable mineral or coal deposit regardless of
whether the land is state owned.
Surveying by geophysical or geochemical methods
Drilling exploration holes
Conducting underground exploration
Surface trenching and bulk sampling
Performing other exploratory work, including aerial photographing, geological and geophysical
logging, sample analyzing and metallurgical testing
Part II. Property Information
If a deposit has been established to exist, enter the location and legal description of the prospect/mineral property for
which you will apply for a mineral and coal exploration tax credit. Include all meridians, townships, ranges and sections.
________________________________________________________________________________________________
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Enter the claim names and/or the serial numbers for the prospect/mineral property and the date that the mineral rights to
these locations were acquired.
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