<p> DIVISION OF PLANNING KENTUCKY TRANSPORTATION CABINET TRANSPORTATION OFFICE BUILDING 5TH FLOOR WEST 200 MERO STREET FRANKFORT KY 40601-9883</p><p>(fold here)</p><p>COAL SHIPMENT ROUTE AND TONNAGE REPORT</p><p>PURPOSE OF REPORTS: These reports determine the ton-mile data that is used in the formula which returns severance tax revenue to counties. Tons data is also used to update/revise the Extended Weight Coal Haul Road System.</p><p>DUE DATE: Each semi-annual report is due 30 days after receipt of this notice.</p><p>FORM INSTRUCTIONS REPORTING COMPANY: Name and complete address of reporting company, severance tax number used to pay tax on coal, and phone number where contact person can be reached during normal daytime working hours. 1. ORIGIN a) Name of Unit: Contract miner or company assigned name or number. b) County: Kentucky county where origin unit is located (for coal shipped into Kentucky, use first Kentucky county and road number at state line). c) Permit #: Permit number assigned by Department for Natural Resources, Division of Mine Permits d) Latitude and Longitude: Location of unit in degrees, minutes, and seconds (found in permit or license package). e) Type of Operation: Check type of unit.</p><p>2. DESTINATION a) Name of Destination: Specific name of tipple, dock, prep plant, etc. in Kentucky to which coal is shipped (do not use town or area for name of destination). b) Road: Road number or name where destination is located (out-of-state routes, use last Kentucky road to exit state). c) County: Kentucky county where destination is located (for coal shipped out of state, use the last Kentucky county before exiting state). 3. TONS TRUCKED: Tons shipped from one origin to one destination during reporting period.</p><p>PLEASE NOTE The permit number, latitude and longitude, destination, and the specific road number or name where coal begins traveling on public roads must be included on this form so we can include your tons in the ton-mile calculations. Please TAPE form closed for return mail. Post Office requests NO STAPLES PLEASE.</p><p>For more information or to access the forms electronically, go to http://transportation.ky.gov/Planning/Pages/Coal-Haul.aspx</p><p>Kentucky Transportation Cabinet Division of Planning COAL SHIPMENT ROUTE AND TONNAGE REPORT TC 59-100 1/2013</p><p>REPORTING PERIOD (Year, Months): ______</p><p>REPORTING COMPANY: Phone: Address: City: State: Zip: Local Contact Person: Severance Tax No: Email Address: Coal Shipment Route and Tonnage Report #1 1. ORIGIN/Name of Unit: County Permit # - Latitude ° ' " Longitude ° ' " File # Type of Operation: Prep Plant/Tipple Surface Mine Underground Mine Other</p><p>If other, please specify): 2. NAME OF DESTINATION Road County 3. TONS TRUCKED from ONE ORIGIN to ONE DESTINATION List below all State, County, and/or City roads used from above ORIGIN to DESTINATION</p><p>COUNTY ROUTE # ROAD NAME BEGMILEPOINT* DIRECTION ENDMILEPOINT* LENGTH</p><p>Coal Shipment Route and Tonnage Report #2 1. ORIGIN/Name of Unit: County Permit # - Latitude ° ' " Longitude ° ' " File # Type of Operation: Prep Plant/Tipple Surface Mine Underground Mine Other</p><p>If other, please specify): 2. NAME OF DESTINATION Road County 3. TONS TRUCKED from ONE ORIGIN to ONE DESTINATION List below all State, County, and/or City roads used from above ORIGIN to DESTINATION</p><p>COUNTY ROUTE # ROAD NAME BEGMILEPOINT* DIRECTION ENDMILEPOINT* LENGTH</p><p>Coal Shipment Route and Tonnage Report #3 1. ORIGIN/Name of Unit: County Permit # - Latitude ° ' " Longitude ° ' " File # Type of Operation: Prep Plant/Tipple Surface Mine Underground Mine Other</p><p>If other, please specify): 2. NAME OF DESTINATION Road County 3. TONS TRUCKED from ONE ORIGIN to ONE DESTINATION List below all State, County, and/or City roads used from above ORIGIN to DESTINATION</p><p>COUNTY ROUTE # ROAD NAME BEGMILEPOINT* DIRECTION ENDMILEPOINT* LENGTH Kentucky Transportation Cabinet Division of Planning COAL SHIPMENT ROUTE AND TONNAGE REPORT TC 59-100 1/2013</p><p>*MILEPOINT information available on-line on the interactive map at http://maps.kytc.ky.gov/photolog/?config=GeneralHighway, the route log query at http://apps.transportation.ky.gov/DMI_Reports/Official_MP_RL_params.aspx, at the Highway District Office, or from the Division of Planning at 502-564-7183. **Form available electronically from the Division of Planning, Roadway Systems Team or at http://transportation.ky.gov/Planning/Pages/Coal-Haul.aspx.</p>