Cal. Code Regs. Tit. 14, div. 2, ch. 8, subch. 1, art. 8, form MRRC-4L
State of California
DEPARTMENT OF CONSERVATION
Request for Exemption from Method of Fee Assessment
MRRC-4L (Revised 04/97)
Requested by:__________
Mine Operator or Mining CompanyLOW-GROSS EXEMPTION FEE REQUEST FOR 1996 REPORTING PERIOD
Non-Governmental operators with only one surface mining operation in the State (operation must be active) which had a gross income of less than $100,000 for the 1996 reporting period may qualify for a reduced reporting fee of $200, if answers to ALL of the following questions are "YES", and this form is submitted by July 1, 1997:
| Yes [] | No [] | 1. | Is all the material extracted from one surface mining operation? | |
| Yes [] | No [] | 2. | Does the operation have Lead Agency approval of a Reclamation Plan and Financial Assurance(s)? | |
| Yes [] | No [] | 3. | Are all of the single operator or mining company's surface mining activities which are located in the State of California tied to, or located on, this one site? | |
| Yes [] | No [] | 4. | Is the amount of gross income of the surface mining operation, for the 1996 calendar year, less than one hundred thousand dollars ($100,000)? | |
| Yes [] | No [] | 5. | Will proof of gross income be attached to this request in the form of a signed, federal tax return(s), or a report prepared and signed by a certified public accountant (CPA)? | |
| Should number 5 above be fulfilled by submitting a Federal tax return(s), the request may be denied for failure to supply a signed Federal Internal Revuene Service Form 4506 if requested by the Department. Form 4506 will allow the Department to verify submitted tax records with IRS records (CCR Section 3699 [a]). | ||||
| Yes [] | No [] | 6. | Will the owner or operator of the operation submit by July 1, 1997, all of the following: | |
| a) The 1996 Mining Operation Annual Report (form MRRC-2)? | ||||
| b) The reporting fee of two hundred dollars ($200)? | ||||
| c) This completed request form? | ||||
| d) Proof of gross income less than $100,000, as specified in Item 5 above? | ||||
IF YOU ANSWERED "NO" TO ANY OF THE QUESTIONS ABOVE (ITEMS 1-6), THE OPERATION DOES NOT MEET THE LOW-GROSS EXEMPTION FEE REQUIREMENTS OF THE TITLE 14, CALIFORNIA CODE OF REGULATIONS (CCR) SECTION 3699. IF YOU ANSWERED "YES" TO ALL OF THE ABOVE QUESTIONS, COMPLETE THIS FORM AND SUBMIT IT BY JULY 1, 1997, TO THE OFFICE OF MINE RECLAMATION WITH THE 1996 MINING OPERATION ANNUAL REPORT.
CA Mine ID#__________. Mine Name__________(as reported on form MRRC-2).
Annual Gross Income $__________ (attach a copy of your signed, Federal Income Tax return(s), or a report prepared and signed by a Certified Public Accountant [CPA]).
Date Reclamation Plan was approved by Lead Agency __________
Date Financial Assurance(s) was approved by Lead Agency __________
If the Department of Conservation (Department) determines that the low-gross exemption is not warranted, the operator shall either:
I certify that the information submitted herein is complete and accurate (failure to submit complete and accurate requisite information may result in the imposition of an administrative penalty of up to $5,000 a day, as provided for in PRC Section 2774.1). Additionally, I understand that submittal of this form to the Department of Conservation after July 1, 1997, does not constitute a valid Low-Gross Exemption Fee request.
| ___________________________ | ___________________________ | ___________________________ | ||
| Signature | Title | Date |
Cal. Code Regs. Tit. 14, div. 2, ch. 8, subch. 1, art. 8, form MRRC-4L