MI-21271 Stone Mining and Quarrying, and Sand and Gravel Mining

Attachment B

2012 ECONOMIC CENSUS

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

Stone Mining and Quarrying, and Sand and Gravel Mining

FORM

MI-21271

OMB No. 0607-0939: Approval Expires

(DRAFT)

(Please correct any errors in this mailing address.)

DUE DATE
FEBRUARY 12, 2013
Need help or have questions?
• Read the accompanying information sheet(s) before
answering the questions.
• Visit

MI-21271

econhelp.census.gov

• Call 1-800-233-6136, between 8:00 a.m. and 6:00 p.m.,
Eastern time, Monday through Friday.

Report Online - It's fast and secure!
Go to:
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U.S. CENSUS BUREAU
1201 East 10th Street
Jeffersonville, IN 47134-0001

Mail your
completed
form to:

- OR -

YOUR RESPONSE IS REQUIRED BY LAW. Title 13, United States Code, requires businesses and other organizations
that receive this questionnaire to answer the questions and return the report to the U.S. Census Bureau. By the same
law, YOUR CENSUS REPORT IS CONFIDENTIAL. It may be seen only by persons sworn to uphold the confidentiality
of Census Bureau information and may be used only for statistical purposes. Further, copies retained in respondents'
files are immune from legal process.
• Use blue or black ballpoint pen.
• Do not use pencil or felt-tip pen.
• Do not put slashes through 0 or 7.

• Please center numbers in
their respective boxes.
• Place an "X" inside the box.

Examples:

The reporting unit for this form is an establishment. An establishment is generally a single physical location
where business is conducted or where services or industrial operations are performed. For further clarification, see
information sheet(s).
1

EMPLOYER IDENTIFICATION NUMBER
Is the Employer Identification Number (EIN) shown to the left of the mailing address the same as the one used for this
establishment on its latest 2012 Internal Revenue Service Form 941, Employer's Quarterly Federal Tax Return?

21271010

0021

2

Yes - Go to

2

0022

No - Enter current EIN (9 digits)

-

0025

PHYSICAL LOCATION
A. Is this establishment's physical location the same as shown in the mailing address?
(P.O. Box and rural route addresses are not physical locations.)
0031

0032

Yes - Go to line B
No - Enter
physical
location

0035

Number and street

0036

City, town, village, etc.

0037

State

0038

ZIP Code

CONTINUE WITH
PENALTY FOR FAILURE TO REPORT

2

ON PAGE 2
CONTINUE ON PAGE 2

Form MI-21271
2

Page 2

(DRAFT)

PHYSICAL LOCATION - Continued
B. Is this establishment physically located inside the legal boundaries of the city, town, village, etc.?
(Mark "X" only ONE box.)
0041

Yes

0042

No

0043

No legal boundaries

0044

Do not know

0024

Do not know

C. In what type of municipality is this establishment physically located?
(Mark "X" only ONE box.)
0046

3

City, village,
or borough

0047

Town or township

0048

Other

OPERATIONAL STATUS
Which of the following best describes this establishment's operational status at the end of 2012?
(Mark "X" only ONE box.)
0011

In operation

0016

Under construction, development, or exploration

0013

Temporarily or seasonally inactive

0014

Ceased operation - Give date at right

0015

Sold or leased to another operator - Give date at right
AND enter name and address of new owner or operator
and Employer Identification Number (EIN) below
0060

Month

Day

Year

0018

Name of new owner or operator

0061

EIN (9 digits)

0062

Mailing address (Number and street, P.O. Box, etc.)

0063

City, town, village, etc.

0064

State

0065

ZIP Code

4

Mark "X"
if None

MONTHS IN OPERATION

30 .)

. . . . . . . . . .

0002

21271028

Number of months in operation during 2012 (If none, mark "X" and go to

2012
Number

CONTINUE ON PAGE 3

Form MI-21271

Page 3

(DRAFT)

If not shown, please enter your 11-digit Census File
Number (CFN) from the mailing address.

HOW TO
REPORT
DOLLAR
FIGURES

5

Mark "X"
if None

Dollar figures should be rounded to
thousands of dollars.
If a figure is $2,035,628.79:

Report

If a value is "0" (or less than $500.00):

Report

$ Bil.

2012
Mil.

Thou.

2

0 3 6

EXAMPLE

SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Mark "X"
if None

Exclude nonoperating income such as royalties, interest, dividends,
or the sale of fixed assets.
A. Total value of products shipped and other receipts (Report detail
in 22 .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$ Bil.

2012
Mil.

Thou.

0100

B. Value of products exported (This is a breakout of the value
reported on line A.)
Report the value of products shipped for export. Include
shipments to customers in the Panama Canal Zone, the
Commonwealth of Puerto Rico, and U.S. possessions, as well as
the value of products shipped to exporters or other wholesalers
for export. Also, include the value of products sold to the U.S.
Government to be shipped to foreign governments. . . . . . . .
6

Not Applicable.

7

EMPLOYMENT AND PAYROLL

0130

Include:
• Full- and part-time employees working at this establishment whose payroll was reported on Internal Revenue
Service Form 941, Employer's Quarterly Federal Tax Return, and filed under the Employer Identification
Number (EIN) shown to the left of the mailing address or corrected in 1 .
Exclude:
• Full- or part-time leased employees whose payroll was filed under an employee leasing company's EIN.
• Temporary staffing obtained from a staffing service.
• Subcontractors and their employees.
For further clarification, see information sheet(s).

21271036

A. Number of employees
1. Number of mining, production, development, and exploration workers for
pay period including March 12 . . . . . . . . . . . . . . . . . . . . . .

0325

2. All other employees for pay period including March 12 . . . . . . . . . .

0336

3. TOTAL (Add lines A1 and A2.) . . . . . . . . . . . . . . . . . . . . . .

0320

Mark "X"

B. Payroll before deductions (Exclude employer's cost for fringe benefits.) if None
1. Annual payroll

2012
Number

Mark "X"
if None

. . . . . . . . . . . . . . . . . . . . . . .

0300

2. First quarter payroll (January-March, 2012) . . . . . . . . . .

0310

$ Bil.

2012
Mil.

Thou.

8 – 12 Not Applicable.

CONTINUE ON PAGE 4

Form MI-21271

Page 4

(DRAFT)

13 CAPITAL EXPENDITURES AND ASSETS
A. Capital expenditures during year (Exclude land and mineral rights.
Include cost of capitalized development, exploration, plant and
other construction, machinery and equipment installed. Include
new and used plant and equipment.) . . . . . . . . . . . . . . .

0563

B. Capital expenditures for land and mineral rights

. . . . . . . . .

0537

C. Gross value of depreciable and/or depletable assets at the end of
the year . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0505

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

Mark "X"
if None

$ Bil.

2012
Mil.

Thou.

14 RENTAL PAYMENTS

Buildings, machinery, and equipment (Include land.) . . . . . . . . .

0550

15 Not Applicable.
16 COST OF SUPPLIES, RESALES, FUELS, ELECTRICITY, AND WORK DONE
FOR YOU BY OTHERS
Cost of supplies used, minerals received for preparation, purchased
machinery installed; cost of products bought and sold as such without
further processing; cost of purchased fuels consumed for heat, power,
or the generation of electricity; and cost of purchased electricity; and
cost of work done for you by others . . . . . . . . . . . . . . . . .

0420

17 – 21 Not Applicable.

Line No.

22 DETAIL OF SALES, SHIPMENTS, RECEIPTS, OR REVENUE
Description
0734

Census product
code
0730

Unit of
measure for
quantities
0736

Shipments and interplant transfers
Value, f.o.b. establishment
Quantity
$ Bil.
Mil.
Thou.

Quantity of
production
0733

0732

0731

Crushed or broken stone
1

Limestone

2

Granite

. . . . . . . .

212312 0100

. . . . . . . . . .

212313 0100

short tons

Other stone (Specify
kind.)

21271044

3

4

212319 0121

Construction sand and
gravel (run of pit or bank,
washed, screened, or
otherwise treated) . . . . . .

212321 0100

CONTINUE WITH

22

ON PAGE 5

CONTINUE ON PAGE 5