Report on a calendar year basis. If this report is prepared on a date prior to January 1, any change in real property between the date when the report is prepared and January 1 must be reported to the Assessor on a supplemental report.

All personal property, excluding stockpiles, owned by you and any property belonging to others at this location as of January 1 must be reported to the Assessor on a Business Property Statement form.

Use the attached map to clearly describe and locate the property.

Line numbers listed in these instructions refer to identical line numbers printed on the form. At top of form, fill in the year of the lien date for which this production report is made.

1. NAME AND MAILING ADDRESS
   1. NAME OF OPERATOR (PERSON OR CORPORATION)
      If the name is preprinted, check the spelling and correct any error. In the case of an individual, enter the last name first, then the first name and middle initial. Partnerships must enter at least two names, showing the last name, first name and middle initial for each partner. Corporation names should be complete so they will not be confused with fictitious or DBA (Doing Business As) names.
   2. DBA OR FICTITIOUS NAME
      Enter the DBA name under which you are operating in this county below the name of the sole owner, partnership or corporation.
   3. MAILING ADDRESS
      Enter the mailing address of the legal entity shown in line 1b above. This may be either a street address or post office box number. Include the city, state, and zip code.
   
   
2. TELEPHONE NUMBER
   Enter the telephone number where we may contact you or your authorized representative for information regarding the subject property.


3. Describe the mining claim(s) you hold if this has not been done by the Assessor.


4. If any of your claims have been quitclaimed or abandoned, indicate this by checking one of the boxes. Also identify those on the line provided.


5. If any claims were acquired by you through purchase or if you sold any of your claims since January 1 of last year, complete this section in detail.

8. Fill in the year for the last calendar year. List all active claims for the last calendar year, the minerals recovered from each claim, the quantity recovered, and the gross income by mineral.


9. PARCEL NUMBER OR BILLING NUMBER
   Show the parcel number or Assessor's billing number, if known.

Note: Milling equipment, mining equipment, materials, and supplies must be reported on a Business Property Statement form.

DECLARATION BY ASSESSEE

The law requires that this production report, regardless of where it is executed, shall be declared to be true under penalty of perjury under the laws of the State of California. The declaration must be signed by the assessee, a duly appointed fiduciary, or a person authorized to sign on behalf of the assessee. In the case of a corporation, the declaration must be signed by an officer or by an employee or agent who has been designated in writing by the board of directors, by name or by title, to sign the declaration on behalf of the corporation. In the case of a partnership, the declaration must be signed by a partner or an authorized employee or agent. In the case of a Limited Liability Company (LLC), the declaration must be signed by an LLC manager, or by a member where there is no manager, or by an employee or agent designated by the LLC manager or by the members to sign on behalf of the LLC.

When signed by an employee or agent, other than a member of the bar, a certified public accountant, a public accountant, an enrolled agent or a duly appointed fiduciary, the assessee's written authorization of the employee or agent to sign the declaration on behalf of the assessee must be filed with the Assessor. The Assessor may at any time require a person who signs a production report and who is required to have written authorization to provide proof of authorization.

A production report that is not signed and executed in accordance with the foregoing instructions is not validly filed. The penalty imposed by section 463 of the Revenue and Taxation Code for failure to file is applicable to unsigned production reports.