Form Mmn-4 - Statement Of Net Proceeds Of Mines Garnet Producers Only
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3MONTANA
MMN-4
Statement of Net Proceeds of Mines
Rev. 07-09
Garnet Producers Only
For Year Ending December 31, 20 ____
Title 15, Chapter 23, Part 5, MCA
Name:
Address:
Address:
City:
State:
Zip Code:
1. FEIN:
2. Account ID:
q
3. Period:
4. If this is an amended return, check here.
q
, enter the final date. __________
5. If you are no longer in business and want your account cancelled, check this box
q
6. If your mailing address has changed, check this box
and print new address below:
____________________________________________________________________
____________________________________________________________________
Name of Mine:
County:
Section:
Township:
Range:
School District:
7. Total tons of ore extracted during production year ............................................................... 7.
8. Total tons of Garnets extracted............................................................................................. 8.
9. Garnet value per ton ............................................................................................................. 9. $
10. Taxable Value (line 8 X line 9) ............................................................................................ 10. $
11.
Type of By-Products
Quantity
Gross Value
$
$
$
$
$
$
12. TOTAL GROSS VALUE of All By-Products ........................................................................ 12. $
13. Gross Value of Garnets Times 100% (line 10 X 100%) ...................................................... 13. $
14. Gross Value of By-Products times 30% (line 12 X 30%) .................................................... 14. $
15. Total Net Proceeds for Mine Owner or Operator (line 13 + line 14) ................................... 15. $
For Internal Use Only
Mineral Exemption # ____________
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 affirm 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
Questions? Call toll free (866) 859-2254 (in Helena, 444-6900).
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