Form MINE-CERT "Application and Affidavit for Certification and Approval of Mineral and Coal Exploration Incentive Credits" - Montana

What Is Form MINE-CERT?

This is a legal form that was released by the Montana Department of Revenue - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2013;
  • The latest edition provided by the Montana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MINE-CERT by clicking the link below or browse more documents and templates provided by the Montana Department of Revenue.

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Download Form MINE-CERT "Application and Affidavit for Certification and Approval of Mineral and Coal Exploration Incentive Credits" - Montana

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MONTANA
CLEAR FORM
MINE-CERT
Rev 06 13
Application and Affidavit for Certification
and Approval of Mineral and Coal Exploration Incentive Credits
15-32-504, MCA
Application for the year ending December 31, ________
This application must be submitted no later than 60 days after the close of the above-listed calendar year.
Name of Applicant _________________________________________________________________________________
Address of Applicant _______________________________________________________________________________
Project Name (if any) _______________________________________________________________________________
Project Area (for general reference purposes) ___________________________________________________________
Part I. Eligible Costs
Enter the total amount of exploration incentive credit costs from Part IV, Line 9, of this application.
$ _______________
Specific activities for which costs may be taken: You may request an exploration incentive credit for the eligible costs
for each of the mineral and coal exploration activities listed below. These activities must be performed for the purpose
of determining the existence, location, extent or quality of a locatable or leasable mineral or coal deposit regardless of
whether the land is state owned.
Surveying by geophysical or geochemical methods
Drilling exploration holes
Conducting underground exploration
Surface trenching and bulk sampling
Performing other exploratory work, including aerial photographing, geological and geophysical
logging, sample analyzing and metallurgical testing
Part II. Property Information
If a deposit has been established to exist, enter the location and legal description of the prospect/mineral property for
which you will apply for a mineral and coal exploration tax credit. Include all meridians, townships, ranges and sections.
________________________________________________________________________________________________
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Enter the claim names and/or the serial numbers for the prospect/mineral property and the date that the mineral rights to
these locations were acquired.
________________________________________________________________________________________________
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________________________________________________________________________________________________
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Page 1
MONTANA
CLEAR FORM
MINE-CERT
Rev 06 13
Application and Affidavit for Certification
and Approval of Mineral and Coal Exploration Incentive Credits
15-32-504, MCA
Application for the year ending December 31, ________
This application must be submitted no later than 60 days after the close of the above-listed calendar year.
Name of Applicant _________________________________________________________________________________
Address of Applicant _______________________________________________________________________________
Project Name (if any) _______________________________________________________________________________
Project Area (for general reference purposes) ___________________________________________________________
Part I. Eligible Costs
Enter the total amount of exploration incentive credit costs from Part IV, Line 9, of this application.
$ _______________
Specific activities for which costs may be taken: You may request an exploration incentive credit for the eligible costs
for each of the mineral and coal exploration activities listed below. These activities must be performed for the purpose
of determining the existence, location, extent or quality of a locatable or leasable mineral or coal deposit regardless of
whether the land is state owned.
Surveying by geophysical or geochemical methods
Drilling exploration holes
Conducting underground exploration
Surface trenching and bulk sampling
Performing other exploratory work, including aerial photographing, geological and geophysical
logging, sample analyzing and metallurgical testing
Part II. Property Information
If a deposit has been established to exist, enter the location and legal description of the prospect/mineral property for
which you will apply for a mineral and coal exploration tax credit. Include all meridians, townships, ranges and sections.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Enter the claim names and/or the serial numbers for the prospect/mineral property and the date that the mineral rights to
these locations were acquired.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Page 1
Applicant Name__________________________________
Part III. Prospect/Mineral Information
1.
Has mining ever occurred on the prospect/mineral property? (Mark one box.)
Yes
No
Unknown
If yes, please provide date(s) in which activity commenced, including, but not limited to, when approvals, licenses,
permits, etc. were issued for the mining activity.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
2.
Please describe all existing improvements made or located on prospect/mineral property such as mine cuts, camps,
wash plants, mill facilities, airstrips, roads, etc. Attach additional sheets if necessary.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
3.
If this application is for a previous mine, please indicate the date that the mine was shut down (month and year).
Please also provide the date(s) when all previous mining approvals, permits, licenses, etc., were terminated.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
4.
Has an Affidavit of Initial Production ever been filed for this property? (Mark one box.)
Yes
No
Unknown
If you answered yes to this question, go to questions 5 and 6. Otherwise, go to question 7.
5.
Enter the date of initial production as indicated on the affidavit (month and year). ________
6.
Enter the final date (month and year) that the title and the mineral rights to prospect/mineral property were acquired.
___________________________________________________________________________________________
Mark the boxes below for each land description that applies:
Land where the prospect/mineral property is located is vacant/unappropriated state/federal land.
Land where the prospect/mineral property is located is claimed, leased or patented by applicant.
Land where the prospect/mineral property is located is claimed, leased, patented, or private land to which the
applicant has acquired the mineral/mining rights.
7a.
Do you have all permits that are necessary to commence construction of a mine?
Yes
No
7b.
List all permit numbers, issuing agencies, type of permits, date of any permits, and status of permits issued as of
the date of this application below. Include such permits as APMA Plan of Operation Approval, Reclamation Plan
Approval, NPDES 401, Solid Waste, Air Quality, Wetlands 404, etc. If you answered “No” to question 7a, please
include in the list below those permits that you have not yet obtained. Attach supplemental sheets, if necessary.
Permit
Number
Issuing Agency Name
Type of Permit
Date of Permit
Status of Permit
_________
__________________
__________________
__________________
________________
_________
__________________
__________________
__________________
________________
_________
__________________
__________________
__________________
________________
_________
__________________
__________________
__________________
________________
8.
Please provide a description of the minerals that you are seeking by the exploration work claimed.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Page 2
Applicant Name__________________________________
Part IV. Breakdown of Exploration Costs Incurred to Bring the Mine into Production
The amount of Mineral and Coal Exploration Incentive Credit allowed is based on the costs incurred for activities in
direct support of exploration activity conducted at a specific exploration site for the purpose of determining the existence,
location, extent, or quality of a mineral or coal deposit. We require a breakdown of the eligible costs associated with this
credit. Eligible costs are the costs incurred during the year for the five mineral and coal exploration activities listed in
Part I on page 1 of this application. The activities must relate to the legal description defined in Part III, line 9. Please see
the instructions for details about the eligibility of these costs. Enter the summary of the costs that you have calculated for
each category below.
1. Personnel Costs ................................................................................................................$ _________________
2. Transportation Costs .........................................................................................................$ _________________
3. Fuel Costs .........................................................................................................................$ _________________
4. Field Camp Costs ..............................................................................................................$ _________________
5. Communication Costs .......................................................................................................$ _________________
6. Geochemical and Geophysical Costs ................................................................................$ _________________
7. Contractual Costs ..............................................................................................................$ _________________
8. Miscellaneous/General Business Operating Costs ...........................................................$ _________________
9. Add the amounts on lines 1 through 8 above and enter the result.
These are your total Exploration Incentive Credit Costs. ...........................................$ _________________
Enter this amount in Part I on page 1 of this application.
Please attach a detailed ledger supporting your totals. Include in your ledger which of the five mineral and coal exploration
activities apply to each detailed cost. You should save all of your receipts and/or cancelled checks because these ledgers
are subject to audit.
Page 3
Applicant Name__________________________________
Part V. Exploration Activity Data List
Please provide a summary of work completed during the year that includes, but is not limited to, 1.) the number of core
or rotary drilling holes completed, 2.) chemical analytical data available, or 3.) aerial photographs or a topographic or
geologic map showing the location of drill holes, sample locations or other exploration activities undertaken. Attach as
many supplemental sheets as necessary.
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Page 4
Applicant Name__________________________________
Part VI. Personnel Information
A.
Enter the number of employees
_____________
B.
List the names of consultants (if necessary, provide the list on an additional page).
1. ______________________________________________________________________
2. ______________________________________________________________________
3. ______________________________________________________________________
4. ______________________________________________________________________
5. ______________________________________________________________________
Part VII. Identification of Business Type
Please mark the box that describes the type of entity applying for the credit.
a partnership registered to do business in the state,
a corporation qualified to do business in the state,
a limited liability company qualified to do business in the state,
a sole proprietorship, or
other, please explain __________________________________________________________________________
Part VIII. Applicant’s Signature
I, ______________________________________________________, under penalty of false swearing, declare that the
information provided in this application and attachments is true, correct and complete.
X ___________________________________________________________ (Signature of applicant)
Subscribed and sworn before me this _______ day of _______________________, 20 ________
Signature of notary ________________________________________________________________________________
My commission expires______________________________________________________________________________
Part IX. Department of Revenue Expenditure Certification/Denial
Amount of certified expenditures ............................................................................ $ _________________________
(Must match the amount shown in Part I)
Date of delivery of above data and request for approval of taking credit ................ _________________________
Month and Year
Signature and date for certifying expenditures
________________________________________________________________
_________________________
Name and Title
Date
Signature and date for not certifying expenditures (See separate letter for reasons of denial and remedy)
________________________________________________________________
_________________________
Name and Title
Date
Mail to: Montana Department of Revenue, Corporation Tax Unit, PO Box 7149, Helena, MT 59604-7149
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