Laserfiche WebLink
COLORDO BOARD OF LAND COMMISSIONERS <br />620 Centennial Building <br />1313 Sherman Street, Suite 621 <br />Denver, CO 80203, (303) 866-3772 <br />MINERAL ROYALTY REPORT <br />Lease Type LT GM GL GP OR UR CY PL GE GS DW OS OM (CIRCLE ONE) <br />State Lease No. _GP3395 Original_X Adjustment <br />County_Conejoes Production Month & Year JANUARY 2005 <br />Lessee_Alamosa County Produced/Operated by <br />Subsection_SEOTR_Section(s)_4 Township_36 Range_8 <br />Product_Pit Run_ <br />Unit of Measure YD TN LB OZ BL OT (CIRCLE ONE) <br />Beginning Inventory <br />Ending Inventory <br />Selling Price per Unit <br />Royalty Rate 0.30 <br />For Adjusted Reports, Previous Amount Paid <br />Units Produced 10275 <br />Units Sold <br />Gross Sales <br />ROYALTY DUE <br />$3,082.50 <br />Advance Minimum Royalty Credit (if applicable) $ <br />ROYALTY PAID$ <br />If this is an adjustment, please explai <br />Contact Name Phil W <br />$3,082.50 <br />Telephone No. (719) _589-6262 <br />I certify that this is a true and correct statement of production sold, value received, and royalty <br />due the State of Colorado for the period indicated. <br />Authorized Signature & <br />Reporting Company Name_Alamosa County Road & Bridge Dept._ Payor Number_701_ <br />Address 8663 S Cnty Rd 109 <br />Alamosa, CO 81101-9423 <br />Subscribed and sworn to before me by <br />On this day of 20 <br />My Commission Expires 20 <br />Notary Public <br />Date Stamp Land Board Use Only <br />Verfied Receipt ~ <br />Posted Date_ <br />Notes:_ <br />S L/0702 <br />