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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 OriginalX Adjustment <br />County_Conejoes Production Month & Year JANUARY 2005 <br />Lessee Alamosa County Produced/Operated by <br />Subsection_SEOTR_Section(s)_4 Township_36Range_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 <br />Royalty Rate <br />For Adjusted <br />per Unit. <br />Units Produced <br />Units Sold <br />Gross Sales <br />10275 <br />0.30 ROYALTY DUE $3,082.50 <br />Reports, Previous Amount Paid $ <br />Advance Minimum Royalty Credit (if applicable) $ <br />ROYALTY PAID$ <br />If this is an adjustment, please explai <br />$3,082.50 <br />Contact Name Phil <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 & Title <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 />Vertied Receipt No. <br />Posted Date <br />SL/0702 <br />