0120 Attachment 4

U.S. Department of the Interior
Minerals Management Service
Minerals Revenue Management

OMB Control Number 1010-0120
Expires October 31, 2007

Solids Minerals Production and Royalty Report
Form MMS-4430

FOR MMS USE ONLY

Customer Name:
Customer Number:
Customer Document ID:
Mine Name:

Business Unit:
(Circle one)
Federal/State/Fee
-orIndian/State/Fee

Payment Due:
Original Data Total:
Other Financial Obligation Total:
Value & Volume Adjustment Total:
Credit Amount:
GRAND TOTAL:

Name of Preparer:
Signature of Preparer:

$

<

>

Payment Method (check one):
Electronic Funds Transfer
Check to MMS
Indian Direct Pay
Indian Lockbox

Credit ID:

Date:
Phone Number:

Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to receive the basic lease-level volume and
valuation information to start our compliance activities. The MMS uses the information to support MMS’s compliance and asset management process. Responses are mandatory (43 U.S.C. 1334).
Proprietary information is protected in accordance with standards established by the Federal Oil and Gas Royalty Management Act of 1982 (30 U.S.C. 1733), the Freedom of Information Act (5
U.S.C. 552(b)(4)), and the Department regulations (43 CFR 2). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB Control Number. Public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining
data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, Minerals Management
Service, Mail Stop 4230, 1849 C Street, NW, Washington, DC 20240.
Page 1
Form MMS-4430 (revised 10/2004)

U.S. Department of the Interior
Minerals Management Service
Minerals Revenue Management

Solid Minerals Production and Royalty Report
Form MMS-4430

OMB Control Number: 1010-0120
Expires: August 31, 2004

Original Data Lease Level Detail
Federal or
Indian
Lease Number

Sales
Month/
Year

Sales Point

Beginning
Inventory

Inventory/
Volume
Adjustment

Gross Proceeds
$

Product

Allowed
Transportation
Cost
$

Units
Produced

Units Transferred

Gross Proceeds

Allowed
Transportation
Cost

Allowed
Processing Costs
$
Production
Available
for Sale

Royalty Rate

Royalty Payment
Due
$

Units Sold

Ending Inventory

Royalty Rate

Royalty Payment
Due
$

Units Sold

Ending Inventory

Royalty Rate

Royalty Payment
Due
$

Units Sold

Ending Inventory

Royalty Rate

Royalty Payment
Due
$

Units Sold

Ending Inventory

Comments:
Federal or
Indian
Lease Number

Sales
Month/
Year

Sales Point

Beginning
Inventory

Inventory/
Volume
Adjustment

$

Product

$
Units
Produced

Units Transferred

Gross Proceeds

Allowed
Transportation
Cost

Allowed
Processing Costs
$
Production
Available
for Sale

Comments:
State
Lease Number

Sales
Month/
Year

Sales Point

Beginning
Inventory

Inventory/
Volume
Adjustment

$

Product

$
Units
Produced

Units Transferred

Gross Proceeds

Allowed
Transportation
Cost

Allowed
Processing Costs
$
Production
Available
for Sale

Comments:
Fee
Lease Number

Sales
Month/
Year

Sales Point

Beginning
Inventory

Inventory/
Volume
Adjustment

$

Product

$
Units
Produced

Units Transferred

Allowed
Processing Costs
$
Production
Available
for Sale

Comments:
Form MMS-4430 (Rev. 11/2003)

Page 2

U.S. Department of the Interior
Minerals Management Service
Minerals Revenue Management

OMB Control Number: 1010-0120
Expires: August 31, 2004

Solid Minerals Production and Royalty Report
Form MMS-4430

Summary and Other Financial Obligations
Mine Data Summary:
Sales
Month/Year

Units
Produced

Product

Gross
Proceeds

Units Sold

$
$
$
$
$

$
$
$
$
$

Totals:

Royalty
Payment

Total
Allowed Cost
$
$
$
$
$

Remote Data Summary:
Sales
Month/Year

Units
Produced

Product

Totals:

Gross
Proceeds

Units Sold
$
$
$
$
$

Royalty
Payment

Total
Allowed Cost
$
$
$
$
$

$
$
$
$
$

Other Financial Obligations Detail:
Other financial obligations are any payment obligations other than production royalty, e.g.; Recoupable Rent, Advance Royalty, Minimum
Royalty, Deferred Bonuses, and Minimum Royalty payable in advance.
Obligation
Due Date
(MMDDYY)

Lease
Number

Obligation
Type

Obligation
Amount

Total:

Form MMS-4430 (Rev. 11/2003)

$
$
$
$
$
$
$

Page 3

U.S. Department of the Interior
Minerals Management Service
Minerals Revenue Management

OMB Control Number: 1010-0120
Expires: August 31, 2004

Solid Minerals Production and Royalty Report
Form MMS-4430

Value and Volume Adjustments
Summary of Changes for the Mine
Sales
Month/Year

Product

MMS/Company Initiated?

Interest Bearing
(Yes/No)

Interest From
Date

Gross Proceeds
Net Change

Processing
Cost Net
Change

Transportation
Cost Net Change

Units
Units
Transferred Net
Produced
Change
Net Change

Units Sold
Net Change

Federal or Indian
Royalty Net
Change

1

$

$

$

$

2

$

$

$

$

3

$

$

$

$

4

$

$

$

$

$

$

$

$

Totals:
Note: Totals for the mine (above) should equal totals for leases and properties (below).

Above Changes for Mine Affect These Leases and Properties
Sales
Month/Year

Product

Federal or State Lease
Number or Fee Property

Gross Proceeds
Net Change

Transportation
Cost Net
Change

Processing Cost
Net Change

Units Produced
Net Change

Units
Transferred
Net Change

Federal or
Indian Royalty
Net Change

Units Sold
Net Change

1

$

$

$

$

2

$

$

$

$

3

$

$

$

$

4

$

$

$

$

5

$

$

$

$

6

$

$

$

$

7

$

$

$

$

8

$

$

$

$

9

$

$

$

$

10

$

$

$

$

11

$

$

$

$

12

$

$

$

$

13

$

$

$

$

14

$

$

$

$

15

$

$

$

$

16

$

$

$

$

$

$

$

$

Totals:
Do you have cascading changes?

Most changes to mine and lease volumes (lease production, transfers, sales) in one month will cause volume changes (to sales, transfers, lease allocations) in subsequent months
(cascading effect). Do any of the volume changes reported above cause changes in mine or lease-level inventories or lease-level allocation ratios for subsequent months? (Yes/No) _______
If the answer is "Yes," prepare another Volume and Value Adjustment page for each affected month. In all likelihood, you will need to submit volume adjustments for all months after
the month you reported changes for (above) through the most recent month for which you submitted original data.

Form MMS-4430 (Rev. 11/2003)

Page 4

U.S. Department of the Interior
Minerals Management Service
Minerals Revenue Management

OMB Control Number: 1010-0120
Expires: August 31, 2004

Solid Minerals Production and Royalty Report
Form MMS-4430

Value and Volume Adjustments
Summary of Changes for the Remote
Sales
Month/Year

Product

MMS/Company Initiated?

Interest Bearing
(Yes/No)

Interest From
Date

Gross Proceeds
Net Change

Transportation
Cost Net
Change

Processing
Cost Net
Change

Units
Units
Transferred Net
Produced
Change
Net Change

Units Sold
Net Change

Federal or Indian
Royalty Net
Change

1

$

$

$

$

2

$

$

$

$

3

$

$

$

$

4

$

$

$

$

$

$

$

$

Totals:
Note: Totals for the remote (above) should equal totals for leases and properties (below).

Above Changes for Remote Affect These Leases and Properties
Sales
Month/Year

Product

Federal or State Lease
Number or Fee Property

Gross Proceeds
Net Change

Transportation
Cost Net
Change

Processing Cost
Net Change

Units Produced
Net Change

Units
Transferred
Net Change

Federal or
Indian Royalty
Net Change

Units Sold
Net Change

1

$

$

$

$

2

$

$

$

$

3

$

$

$

$

4

$

$

$

$

5

$

$

$

$

6

$

$

$

$

7

$

$

$

$

8

$

$

$

$

9

$

$

$

$

10

$

$

$

$

11

$

$

$

$

12

$

$

$

$

13

$

$

$

$

14

$

$

$

$

15

$

$

$

$

16

$

$

$

$

$

$

$

$

Totals:
Do you have cascading changes?

Most changes to remote and lease volumes (lease production, transfers, sales) in one month will cause volume changes (to sales, transfers, lease allocations) in subsequent months
(cascading effect). Do any of the volume changes reported above cause changes in mine or lease-level inventories or lease-level allocation ratios for subsequent months? (Yes/No) _______
If the answer is "Yes," prepare another Volume and Value Adjustment page for each affected month. In all likelihood, you will need to submit volume adjustments for all months after
the month you reported changes for (above) through the most recent month for which you submitted original data.
Page 5
Form MMS-4430 (Rev. 11/2003)