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COLORADO BOARD OF LAND COMMISSIONERS
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1127 Sherman Street, Suite 300
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Denver, CO 80203-2206
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 (303) 866-3454
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https://slb.colorado.gov/royalty
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MINERAL ROYALTY REPORT
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Lease type: LT GM GL GP QR UR CY PL GE GS DW OS OM (circle one)
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State Lease No.:
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County:
Production MM/YY:
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Lessee:
Produced/Operated by:
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Subsection: Section:
Township:
Range:
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Product:Unit of Measure:YD TN LB OZ BL OT
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Beginning Inventory:
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Units Produced:
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Units Sold:
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Adj to physical count:
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Ending Inventory:
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Selling price Per Unit:
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Gross Sales Value:
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Royalty rate (as % or $):
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ROYALTY DUE:
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AMR Credit Balance
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AMR Credit used
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AMOUNT DUE:
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New AMR Credit Balance
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Check Amount:
Check Number:
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If this is an adjustment, please explain:
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Contact Name:
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Telephone:
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Email:
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I certify that this is a true and correct statement of the production sold, value received, and royalty due to the State of Colorado for the period indicated.
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Signature:
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Reporting Company Name:
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Company Address:
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Please submit form to: dnr_colorado_royalty_data@state.co.us
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