Form 5600-FM-BMP0412 "Schedule for Deposit of Collateral Under Collateral Bond - Mining" - Pennsylvania

What Is Form 5600-FM-BMP0412?

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

Form Details:

  • Released on January 1, 2014;
  • The latest edition provided by the Pennsylvania Department of Environmental Protection;
  • 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 printable version of Form 5600-FM-BMP0412 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Environmental Protection.

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Download Form 5600-FM-BMP0412 "Schedule for Deposit of Collateral Under Collateral Bond - Mining" - Pennsylvania

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5600-FM-BMP0412
Rev. 1/2014
COMMONWEALTH OF PENNSYLVANIA
7C-fa-13.0
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF MINING PROGRAMS
License No.
Permit No.
(Department Use Only)
SCHEDULE FOR DEPOSIT OF COLLATERAL
UNDER COLLATERAL BOND — MINING
This schedule is attached to and intended to become made a part of the Collateral Bond — Mining (the ―Collateral
Bond‖) dated
, submitted pursuant to Permit
No.
originally issued on,
by
.
(Name of Mine Operator)
For the purpose of securing the bond obligation referred to in the Collateral Bond, the Operator agrees to deposit
collateral with the Department, acceptable under the Law, in accordance with the following schedule. Time is of the
essence.
It is the responsibility of the Operator to make timely deposits in accordance with this schedule.
The
Commonwealth is in no way responsible for providing the Operator with further notice of this schedule of deposits.
Dollar Amount of
Collateral to be Deposited
Date to be Deposited
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Down payment amount
. $10,000.00 or 25% of the total permit bond amount (whichever is
greater).
The total amount of collateral to be deposited in accordance with this schedule including the down payment is
.
- 1 -
5600-FM-BMP0412
Rev. 1/2014
COMMONWEALTH OF PENNSYLVANIA
7C-fa-13.0
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF MINING PROGRAMS
License No.
Permit No.
(Department Use Only)
SCHEDULE FOR DEPOSIT OF COLLATERAL
UNDER COLLATERAL BOND — MINING
This schedule is attached to and intended to become made a part of the Collateral Bond — Mining (the ―Collateral
Bond‖) dated
, submitted pursuant to Permit
No.
originally issued on,
by
.
(Name of Mine Operator)
For the purpose of securing the bond obligation referred to in the Collateral Bond, the Operator agrees to deposit
collateral with the Department, acceptable under the Law, in accordance with the following schedule. Time is of the
essence.
It is the responsibility of the Operator to make timely deposits in accordance with this schedule.
The
Commonwealth is in no way responsible for providing the Operator with further notice of this schedule of deposits.
Dollar Amount of
Collateral to be Deposited
Date to be Deposited
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Down payment amount
. $10,000.00 or 25% of the total permit bond amount (whichever is
greater).
The total amount of collateral to be deposited in accordance with this schedule including the down payment is
.
- 1 -
5600-FM-BMP0412 Rev. 1/2014
IN WITNESS WHEREOF, the Operator intending to be legally bound hereby, sets its hand and seal, this
day of
, 20
.
OPERATOR:
(Print Operator Name)
By:
(Signature and Title)
By:
(Signature and Title)
(Seal)
Approved as to legality and form:
Preapproved 6/11/13
Office of Attorney General
Preapproved
5/3/13
Office of General Counsel
Chief/Assistant Counsel - Department of Environmental Protection
Approved for the Department:
Bureau of Office Services
- 2 -
5600-FM-BMP0412 Rev. 1/2014
ACKNOWLEDGEMENT
COMMONWEALTH /STATE OF
:
COUNTY OF
:
A
TO BE USED BY AN OPERATOR THAT IS A CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY
of MUNICIPAL AUTHORITY
On
,
and
(Date)
(Name)
], personally appeared before me, and identified
(Name)
(himself, and/or herself or themselves – please CIRCLE what is accurate) as the
[and
, respectively,]
(Title)
(Title)
of
,
(Name of Operator – must be identical to Operator identified in Bond)
Each affiant stated that, in accordance with (1) Please CIRCLE ONE AND ONLY ONE [the bylaws of the corporation or
Municipal Authority] the Partnership Agreement] [the Operating Agreement of the LLC or the LLP] and/or (2) any other
documents that state who is authorized to act on behalf of the Operator, the affiant was authorized to sign the attached
Bond on behalf of the Operator
B
TO BE USED BY AN OPERATOR THAT IS AN INDIVIDUAL
On
(Date)
(Name)
Personally appeared before me, and acknowledged that he or she executed the attached Bond for the purposes therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
My Commission Expires:
(Notary Public Signature)
(Date)
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