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COLORDO BOARD OF LAND COMMISSIONERS <br />620 Centennial Building <br />1127 Sherman Street, Suite 300 <br />Denver, CO 80203 <br />MINERAL ROYALTY REPORT <br />Lease (ape LT GM GL GP QR UR CY PL GE GS DW OS OM (CIRCLE ONE) <br />State Lease No. _GP3395 Original X Adjustment <br />County_Conejoes Production Month & Year SEPTEMBER 2010 <br />Lessee _Alamosa County Produced/Operated by <br />Subse(.tion_SEQTR_Section(s)_4 Town ship_36 Range_8 <br />Product Pit Run _ <br />Unit of 1 ieasure YD TN LB OZ BL QT (CIRCLE ONE) <br />Beginning Inventory Units Produced 1653 <br />Ending Inventory Units Sold <br />Selling Price per Unit Gross Sales <br />Royalty Rate 0.30 ROYALTY DUE $495.90 <br />For Adjusted Reports, Previous Amount Paid $_ <br />Advance Minimum Royalty Credit (if applicable) $ <br />ROYALTY PAID$ <br />If this is an adjustment, please explain <br />$495.90 <br />Contact Name Phil West Telephone No. (719 ) _589-6262 <br />----------------------------------------------------------------------------------------------------------- <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 />Autf prized Signature & Title <br />Rep )rting Company Name_Alamosa County Road & Bridge Dept._ Payor Number. <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 />iik,l Commission Expires 20 <br />` ota:-y . !!C <br />Date Stamp Land Board Use Only <br />Verfied Receipt No. <br />Posted Date <br />Nn!es: <br />701 <br />S L.-Irl