SV 5          Rev. 5/13

                                                                                                                                        (E)

                                                                                                                                                                    Surface Mining                                                                                                                                                                                                                                                                                                                                  to line 1B of the SV3.
                                                                                                                                                                                                                                                                                                                                                                              extracted below. If not, enter -0-.                                                                                          0Transfer Column (E) subtotal 
                                                                                                                                                                                                                                                    If the permitted location is mined using 
                                                                                                                                                                                                                                                                                                                                   surface mining methods, enter the quantity 

                                                                                                                                     (D)

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    to line 1A of the SV3.
                                                                                                                                                                                                                                                                                                                                                                              the cost of reclamation, enter -0-;                                                                                          0Transfer Column (D) subtotal 
                                                                                                                                           Reclamation Quantity                                        If the permitted location has posted a                                                performance security adequate to cover
                                                                                                                                                                                                                                                                                                                                                                              otherwise enter the quantity extracted below

                                                                                                          Account No.                (C)
                                                                                                                                                                                                                                              (Tons)
Reset Form                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          to line 1 of the SV3.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Page __ of __
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           0Transfer Column (C) subtotal 
                                                                                                                                           Total Quantity Extracted 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Use additional pages as needed.

                                                                                  Additional Taxes on Coal
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Subtotal:

                                                                                                                                     (B)

                                                                                                                                           Location Name

                                                                                                                                     (A)
                       P.O. Box 530                        Columbus, OH 43216-0530
                                                                                                                                           Permit Number                                                                                                                                     of Natural Resources

                                                                                                                                                                                                       As assigned by the Ohio Department 

                                                                                                          Name        Address Period                                                                                                                                                                                                                                                                                          1.      2.      3.      4.      5.      6.      7.      8.      9.       10.