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<br />' t•°"^ ~~ °-= COF.L PFiODUGTIOlJ AND RE::I AIJIAT ICJ\' FEE REPORT I
<br />-- Fc~D Irv ST R'JCTIOrdS Ri FORE CCRJPLETReG HIS Fpardrl~_
<br />>~~%.??i:= == t! prennntcd Int urmatiun Is lutur ect of minu\y mra ie co•rrn ions of
<br />_^'-"-~~Z""T addllinns In Item 14 nnlt• Do not w•rnr In Items 3 12.
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<br />Cf'{~•Irllr~r DD $192 Gty State - Z.~
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<br />LOCATION OF MINE
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<br />7. Name of Mine County j] 1 °. State QA 10. Nearesl'• 1rivn ,.; _'`, •::
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<br />17. Name o7 Coraact Person Telephone .Number . ~ "::112. Indian,'P,e~;~alior.ler+dJgl~
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<br />.r?~ r-- 13. PRODUCTION AND FEE COMPUT;4TIO.N
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<br />Coat Mining h7ethod Number of Tons n '...
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<br />(e1 Subject to the Fee tand9rd • , Percentage
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<br />Surface
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<br />75 ctnu ''
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<br />Lignite ~ x 10 renU~:• ~' or..' ~;~n15>S : ,P 4~,. ~, -_ a;, ~;{r,
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<br />Total Fee To Be Paid No taier Than Thirty 130) Days After The End - - ~
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<br />Of The Calendar Quarter .. ~~'
<br />14. Corrections or Additions (Identify by Item Number, . 15.~O SM•Use'Dnly;; it: ~ ~ =w :'~"',',t"'~;~'~~~
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<br />Attach Sheet ii More Space is Neededl. 'r '• •:e:r.,, ..,;
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<br />PLEAgE 7+'RITE 'I If1E ID 05030b5 Oz rr '' Grn•'i-.CcdC:. ;"' - ~:- ~
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<br />DN-Ynu~• CHECK cceiptCo ~,(. - .- : ;r'
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<br />=•r ti~,~ T'~ = 16. CERTIFICATION , r ~ ~~•
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<br />(a-) 'THEREBY CERTIFY that the statements make herein ~ ..:~dj5ti'o[crlr,rd and loin to Me ihic_~,~_l}aY:
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<br />are true, complete, and correct to tht best o1 my know ~ ~• +g ~ N e p tserice of ' ~ ~ ~ „y'y ~~
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<br />ledoe and beGei, and ere made in good faith.
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