Form 8101 - Annual Gross Products Report For Coal Page 7
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7State of Wyoming
ANNUAL GROSS PRODUCTS
8101
Department of Revenue
REPORT FOR COAL
*8101*
122 West 25th Street
Cheyenne, WY 82002-0110
Production Year:
TAXPAYER INFORMATION
__ __ __ __
Operator
Revenue Use Only
MINE INFORMATION
Taxpayer
Mine Group Number
Contact Person / Agent
Telephone Number
Mine Group Name
Address
DEQ Permit Number
City
State
Zip
County
O = Original
Form Type:
Mineral Type:
Surface Coal
Underground Coal
A = Amended
Production, Sales, and Taxable Value for Coal Sold Away From the Mouth of the Mine
tons
value
1a. Long-Term
$
3a. Severance Taxes
$
1b. Spot Sales
$
3b. Gross Products Taxes
$
1c. Intercompany Sales
$
3c. AML Fees
$
1d. Feedstock Sales
$
3d. Black Lung Taxes
$
1. Total Sales
$
3. Total Production Taxes
$
2a. Private Royalty
$
4a.Total Direct Mining Cost
2b. Federal Royalty
$
4b. Total Direct Cost
2c. State Royalty
$
4. Direct Cost Ratio
.
2d. Tribal Royalty
$
2. Total Royalty
$
5. Total Tons Mined
6. Net Sales Value (Line 1 ($) - Line 2 ($) - Line 3)
$
7. Net Sales Value x Direct Cost Ratio (Line 6 x Line 4)
$
8. Taxable Value of tons Sold (Line 7 + Line 2a ($) + Line 3)
$
9. Taxable Value per tons sold (Line 8 / Line 1 (tons))
$ / ton
10. Taxable Value of Coal Sold Away from Mine Mouth (line 9 x Line 5)
$
Production and Taxable Value Summary
Tons
Taxable value
11. Production and Taxable Value of Mine Mouth Sales
(line 4 and line 7 from mine mouth sales attachment)
12. Production and Taxable Value of Coal Sold away
From Mouth of the Mine (line 5 and line 10 above)
13. Total Production and Taxable Value
(Line 11 + Line 12)
I declare under penalty of perjury that I have examined this return, and , to the best of my knowledge and belief, it is correct and complete.
MTS2
2/05/10
Authorized Signature
Title
Date
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