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I <br /> State of Colorado <br /> 16 DPT-AS EARTH OR STONE PRODUCTS REAL AND PERSONAL <br /> FORM DS-648 79-16 PROPERTY DECLARATION SCHEDULE <br /> (CONFIDENTIAL DATA) Assessment Date Due Date <br /> January 1, April 15, <br /> OURAY County RETURN TO COUNTY ASSESSOR 2016 2016 <br /> B.A.CODE T.A.CODE SCHEDULE NUMBER DO NOT USE—FOR ASSESSOR ONLY <br /> Code Description Acres Tons Actual % Assessed <br /> Value Value <br /> A. NAME AND ADDRESS Earth or Stone <br /> (INDICATE ANY CHANGES/CORRECTIONS) 512o Products $ 29% $ <br /> TODD HAYNES <br /> 12696 6450 ROAD 522o Improvements $ 29% $ <br /> MONTROSE CO 81401 <br /> Equip.,Fum.& <br /> PHYSICAL LOCATION/LEGAL DESCRIPTION OF THE 5420 Machin $ 29% $ <br /> PROPERTY AS�OF JANUARY 1 '2016: <br /> /I/Lc t'Ir�E�S l 6 TOTALS $ $ <br /> A� /� RECEIVED APPROVED <br /> '23l6 / �L<���c1Sl� D f. COMPLETED ABSTRACT CHGS. <br /> LATE FILING PENALTY ❑ YES ❑ NO <br /> APPLIED <br /> B. OPERATION: Start-up Date If you are not the current business owner please list the name <br /> and address of the new owner below. <br /> Date Sold <br /> Type of Product <br /> b <br /> BUSINESS (Check the Appropriate Box) NEW NEW <br /> STATUS: BUSINESS OWNER(S) <br /> EA Check this box if this is your first return. <br /> If this is your first return,You MUST furnish a complete itemized listing. <br /> C. PRODUCTION <br /> List the description,volume royalty rate,and retail sale price of any earth or stone extracted during the preceding calendar year. <br /> TYPE OF PRODUCT EXTRACTED TONS : ROYALTY CUBIC YARDS ROYALTY WEIGHTED AVERAGE <br /> EXTRACTED PER TON EXTRACTED PER CU.YD. RETAIL SALE PRICE/UNIT <br /> A. s r t d �ZS $ o,60 o : $ 0, 66 If S.cz� e' ft <br /> B. $ $ <br /> C. $ $ <br /> D. ' $ $ <br /> D. LEASE AND PERMIT INFORMATION Attach a copy of the lease.)_ <br /> NAME OF LESSOR DATE OF LEASE <br /> LENGTH OF LEASE <br /> LEASE OPTIONS DRMS PERMIT NUMBER <br /> E. LAND INFORMATION <br /> PERMITTED ACRES AFFECTED ACRES ESTIMATED LIFE OF DEPOSIT <br /> e ( C<c '•e -� YEARs <br /> F.LISTING OF REAL PROPERTY IMPROVEMENTS attach separate sheets ,if necessary) <br /> List buildings and other improvements constructed or installed the previous year. Include the property description and installation <br /> date,your original installed cost,and any additions since original installation. <br /> Buildings and Other Improvements Description and Location Date of Your Original Additions Since Original <br /> Installation Installed Cost Installation <br /> C <br /> SEE OTHER SIDE <br />