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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 Original_X Adjustment <br />County_Conejoes Production Month & Year JULY 2005 <br />Lessee Alamosa County Produced/Operated by <br />Subsection_SEQTR_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 per Unit <br />Royalty Rate 0.30 <br />For Adjusted Reports, Previous Amount Paid $_ <br />Advance Minimum Royalty Credit (if applicable) $ <br />ROYALTY PAID$ <br />If this is an adjustment, <br />Units Produced 9600 <br />Units Sold <br />Gross Sales <br />ROYALTY DUE $2,880.00 <br />$2,880.00 <br />please explain <br />Contact Name_Phil West Telephone No. (719) _589-6262 <br />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 <br />My Commission Expires_ <br />Notary Pu <br />Date Stamp Land Board Use Only <br />Verfied Receipt No <br />Posted Date <br />20 <br />20 <br />Notes:_ <br />S L/0702 <br />