This document is a statement of net proceeds form for limestone producers in Montana for the year ending December 31. It requires the producer to provide their name, address, FEIN number, account ID, period covered, tonnage and value of limestone extracted, taxable value calculated by tonnage multiplied by value per ton, and a schedule of royalty interests including names, addresses, and amounts paid. The completed form must be signed, titled, and returned by March 31 to the Montana Department of Revenue.