Form 8201 - Wyoming Annual Gross Products For Uranium Page 5
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5State of Wyoming
ANNUAL GROSS PRODUCTS FOR
8201
Department of Revenue
*8201*
URANIUM
122 West 25th Street
Cheyenne, WY 82002-0110
Production Year:
TAXPAYER INFORMATION
__ __ __ __
Operator ID
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
Form Type:
O = Original
A = Amended
Production, Sales, and Taxable Value for Uranium Sold Away From the Mouth of the Mine
lbs
value
value
1a. Long-Term
$
3a. Private Royalty
$
Contract Sales
1b. Spot Sales
$
3b. Federal Royalty
$
1c. Intercompany Sales
$
3c. State Royalty
$
1.
Total Sales
$
3d. Tribal Royalty
$
(lines 1a + 1b + 1c)
3.
Total Royalty
$
(Lines 3a + 3b + 3c + 3d)
2a. Severance Taxes
$
2b. Gross Products Taxes
$
4. Industry Factor
%
2. Total Production Taxes
$
5. Uranium lbs Produced
(Lines 2a + 2b)
6.
$
Net Sales Value (Line 1 ($) - Line 2 - Line 3)
$
7.
Net Sales Value x Industry Factor (Line 6 x Line 4)
8.
$
Taxable Value of lbs. Sold (Line 7 + Line 2 + Line 3a)
9.
Taxable Value per lb sold (Line 8 / Line 1 (lbs.))
$ / lb
10. Taxable Value of Uranium Sold Away from Mine Mouth (line 9 x Line 5)
$
Production and Taxable Value Summary
lbs.
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 Uranium 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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