SMRD-52C

01/2017

RAILROAD COMMISSION OF TEXAS

SURFACE MINING AND RECLAMATION DIVISION

P. O. Box 12967

Austin, Texas 78711-2967

2016 ANNUAL REPORT

The Regulations at 16 Texas Admin. Code §12.108(b) require that each permittee pay an annual fee of $13.05 for each acre of bonded land within a permit area on December 31, 2016, and a fee of $6,600.00 for each permit in effect on December 31, 2016. These fees are due and payable not later than March 15, 2017, and should be reported on this form. Please complete this form and return it with the fee payment (checks should be made payable to the Railroad Commission) to the Surface Mining and Reclamation Division by that date.

If multiple permits exist for a permittee, please submit a separate completed form for each permit. This will ensure that the fee payment can be properly accounted by permit number. The acreages submitted in this report should reflect only the twelve-month period of the calendar year being reported for the permit and not cumulative totals for the mine operations.

MINE NAME: / PERMIT NO.:
PERMITTEE:
MAILING ADDRESS:
(Street Address or P. O. Box Number)
(City) / (State) / (Zip Code)
1. / Permit acres covered by a reclamation bond [16 Texas Admin. Code §12.108(b)(1)]
Bonded Acres (subject to $13.05 per acre) / Ac. / $
2. / Permit fee [16 Texas Admin. Code §12.108(b)(2)] / $ / 6,600.00
($6,600.00 per permit)
Total Fees / $
3. / Coal/Lignite mined, in tons (January 1 - December 31, 2016) / Tons
4. / Disturbed area (January 1 - December 31, 2016)
a. / Mined acres / Ac.
b. / Non-mined acres disturbed / Ac.
5. / Provide topographic maps(s) and/or aerial photographs at a scale of one (1) inch equal to one thousand (1,000) feet or larger showing the location of acres mined, disturbed and bonded for the report year. The map(s) should also be provided in a digital format compatible with CAD or GIS.
I, / ,
(Name - Printed or Typed) / (Title)
state that I have knowledge of the facts herein set forth and that the same are true and correct to the best of my knowledge and belief.
DATE: / AUTHORIZED SIGNATURE: