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GLACIER BANK Payer's <br />BANK OF THE SAN JUANS, DIV. GLACIER Fed I.D. No. <br />144 East 8th Street 81- 0251125 <br />Durango, CO 81301 0 81301 <br />(970) 247 -1818 <br />MASK LLC <br />1313 Sherman Street /Room 215 <br />Denver CO 80203 <br />RECEIVED <br />JAN 15 2014 <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />OMB No. 1545 -0112 <br />Interest Income <br />Form 1099 -INT <br />Copy B <br />For Recipient <br />For year 2013 <br />Recipient's <br /> <br /> <br />Interest Interest on U.S. Federal Tax <br />Account <br /> <br /> T 27.63 <br />---------------------------------------------------------------------------- <br />BOX 1 Interest Income . . . . . . . . . . . . . . . . . . . 27.63 <br />BOX 2 Early withdrawal penalty . . . . . . . . . . . . . . <br />BOX 3 Interest on U.S. Savings Bonds and Treas. obligations <br />BOX 4 Federal income tax withheld . . . . . . . . . . . . . <br />BOX 5 Investment expenses . . . . . . . . . . . . . . . . . <br />BOX 6 Foreign Tax paid . . . . . . . . . . . . . . . . . . <br />BOX 7 Foreign country or U.S. Possession <br />BOX 8 Tax - exempt Interest . . . . . . . . . . . . . . . . . <br />BOX 9 Specified private activity bond interest . . . . . . <br />BOX 10 Tax - exempt bond CUSIP no. (see instructions) . . . . . <br />BOX 11 State . . . . . . . . . . . . . . . . . . . . . . . <br />BOX 12 State identification no. . . . . . . . . . . . . . <br />BOX 13 State tax withheld . . . . . . . . . . . . . . . . . <br />This is important tax information and is being furnished to the <br />Internal Revenue Service. If you are required to file a return, <br />a negligence penalty or other sanction may be imposed on you if <br />this income is taxable and the IRS determines that it has not <br />been reported. <br />(KEEP FOR YOUR RECORDS.) <br />N <br />Q <br />W <br />H <br />y <br />Q <br />X <br />Q <br />F <br />