BOE-560-C

Source: https://www.boe.ca.gov/proptaxes/pdf/sample-boe560c.pdf

THIS PAGE WATERMARKED SAMPLE ONLY CONTACT ASSESSOR FOR ACTUAL FORM

BOE-560-C (P1) REV. 08 (07-25)
OFFICIAL REQUIREMENT 20 This statement is not a public document. The information contained
A report submitted on this form is required of you by section 441(a)
of the Revenue and Taxation Code (Code). The statement must be MINING CLAIM hereindisclosedwillonlybe heldto thesecretdistrictby theattorney,Assessorgrand(Codejury,sectionand other451);agenciesit can be
completed according to the instructions and filed with the Assessor PRODUCTION REPORT specified in Code section 408. Attached schedules are considered
on or before April 1, 20 . Failure to file it on time will compel to be part of the statement.
the Assessor’s Office to estimate the value of your property from
other information in its possession and add a penalty of 10 percent 9. ASSESSOR’S PARCEL OR BILLING NO. (if known)
as required by Code section 463.

Carefully read and follow the accompanying instructions.
If additional detail is necessary, attach separate page. Yes No
1. NAME AND MAILING ADDRESS If yes, which one(s)?

11. HAS THE NOTICE OF ASSESSMENT WORK AND IN-
TENT TO HOLD YOUR CLAIM(S) BEEN FILED WITH THE
FEDERAL BUREAU OF LAND MANAGEMENT BY LAST DECEMBER 30TH? Yes No FORM

(Make necessary corrections to printed name and mailing address)
2. TELEPHONE NO. ( ) Yes No
3. OUR RECORDS INDICATE THAT YOU ARE THE HOLDER OF THE CLAIM(S) LISTED:

YOUR CLAIM(S)? Yes No
BUILDINGS OR MACHINERY ON CLAIMS

Describe in Date Installed Claims on Which ONLY Detail Acquired Cost Located ACTUAL
FOR
4. HAVE ANY OF THE ABOVE CLAIM(S) BEEN QUITCLAIMED OR ABANDONED BY YOU?

Yes No If yes, which ones?

5. IF YOU ACQUIRED OR SOLD ANY OF YOUR CLAIM(S) SINCE JANUARY 1 OF LAST
YEAR, LIST THOSE PURCHASED OR SOLD AND THE PURCHASE OR SALE PRICE. (checkSAMPLEone) Date of Purchase or Claim Name Purchase
or Sale Sale Price Purchase Sale
$

ASSESSOR’S USE ONLY

6. HAS YOUR CLAIM(S) BEEN MINED AT ANYTIME IN THE PAST? Yes No
If yes, when? ASSESSOR
7. IF NOT MINED IN THE PAST YEAR, WHY NOT?

8. OPERATING STATEMENT ( 20 ) (attach separate page if necessary)

Show Quantity of List All Minerals Show Income List Claim(s) Active Each Mineral Recovered on Each For Each Last Calendar Year Recovered on Claim Mineral Each Claim
$CONTACT

THIS REPORT SUBJECT TO AUDIT

BOE-560-C (P2) REV. 08 (07-25) The diagram below represents one square mile of land. Draw the outline of your claim(s) and identify it on this diagram by showing the name, section, township and range next to each claim. Indicate whether claim(s) is lode or placer. For example:

BLUE BIRD #9 (use separate sheets of paper if necessary) SEC. 2 T.3N.,
R.4E. 20 ACRES
LODE N CHAINS
s 20 40 60 80
1 320
FORM
3/4 240
1/2 ONLY 160 W • ACTUAL E
MILES RODS
FOR

1/4 80

s s SAMPLE

s 1320 2640 3960 5280
FEET ASSESSOR S
DECLARATION BY ASSESSEE

Note: The following declaration must be completed and signed. If you do not do so, it may result in penalties.
I declare under penalty of perjury under the laws of the State of California that I have examined this production report, and that the foregoing and all information
herein, including any accompanying statements or materials, is true, correct, and complete to the best of the taxpayer's knowledge and belief, and includes all
production and all property required to be reported which is owned, claimed, possessed, controlled, or managed by the person named as the assessee in this
statement at 12:01 a.m. on January 1, 20 .

OWNERSHIP SIGNATURE OF ASSESSEE OR AUTHORIZED AGENT* DATE
TYPE (3)
NAME OF ASSESSEE OR AUTHORIZED AGENT * (typed or printed) TITLE
Proprietorship

Partnership NAME OF LEGAL ENTITY (other than DBA) (typed or printed) FEDERAL EMPLOYER ID NUMBERCONTACT Corporation PREPARER’S NAME AND ADDRESS (typed or printed) TELEPHONE NUMBER TITLE Other ( )

*Agent: see page 3 for Declaration by Assessee instructions.

BOE-560-C (P3) REV. 08 (07-25)

INSTRUCTIONS FOR COMPLETING MINING CLAIM PRODUCTION REPORT

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. FORM LINE 1. NAME AND MAILING ADDRESS

a. 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.

b. 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.

c. MAILING ADDRESS Enter the mailing address of the legal entity shown in line 1bONLYabove. This may be either a street address or post office box number. Include the city, state, and zip code. ACTUAL

LINE 2. TELEPHONE NUMBER
Enter the telephone number where we may contact you or your authorized representative for information regarding the subject
property.

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

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

LINE 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 ASSESSORproduction 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 imposedCONTACTby section 463 of the Revenue and Taxation Code for failure to file is applicable to unsigned production reports.