REPORTING INSTRUCTIONS
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The Mine Safety and Health
Administration has developed these instructions to aid you in completing the
Legal Identity Report Form 2000-7. �If you are a first time filer, please read
all of the instructions before beginning. ��Remember that all information previously
submitted remains in effect except where changes have been submitted. If the
changes provided on this form affect other mines, a separate form must be
filed for each mine identification number.�
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MSHA will use the TIN for
purposes of collecting and reporting on any delinquent amounts arising out of
assessments made under the Federal Mine Safety and Health Act of 1977 (Mine
Act).� Persons are not required to
respond to the collection of information unless it displays a currently valid
OMB control number.
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Notice: If
this is the first filing of a Legal ID Report for this mine while under the
operation or control of this operator, ALL fields on this Legal ID
Report require completion.
If
an operator wishes to change or supplement information previously submitted
regarding this mine while under his/her control, these mandatory fields
must be completed: Effective Date; Item #1 Federal Mine Identification
Number; Item #2 Mine Name; Item #5 Official Business Name of Operator;
Signature and Title of Official Completing Form; and Date Form
Completed. The only other fields required to be completed are fields
where changes have occurred or additional information is being provided
for information previously submitted.
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Effective Date of Changes � The date the initial information, or changes on
previously submitted information, becomes effective for this mine while under
the operation or control of this operator. �Enter the effective date, using
numbers to show the month, day, and complete year; e.g., 01/01/2002.� Please note
that this is the date that changes actually became effective and is not
necessarily the date you are completing this form.�
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Item #1
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Federal Mine
Identification Number - This seven
digit mine identification number is obtained from the MSHA district office
where the mine is located before mining operations begin.
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Item #2
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Mine Name - The Official business name assigned to this mining
operation.�
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Item #3
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Directions to this Mine - The mileage and directions from the nearest town,
city, and/or landmark should be provided.
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Item #4
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Mine Location Address - The street address, city, state, zip code and
county for this mine.
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Item #5
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Official Business Name of
Operator - The official business
name that will be used for this operation. This should be the name of the
business, not the name of the individual who owns the company, or the name of
the individual involved with the day-to-day operations at the mine.
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Item #6
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Principal Office Address
for this Operator - The complete
office address where the company or organization is doing business.� If located in a rural area, provide the
road name or route number.�
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Item #7
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Telephone Number for this
mine in the Event of an Emergency -
The telephone number for this mine, including area code, where the operator
can be reached in the event of an emergency.
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Item #8
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Commodity (type of
product and operation) - The product
name and type of operation for this mine.
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Item #9
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Person at Mine in Charge
of Health and Safety. (Superintendent or Principal Officer) - The name, title, address, and e-mail address for
the official involved with the day-to-day operations at this mine.
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Item #10
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Person with Overall
Responsibility for a Health and Safety Program at all of the Operator's
Mines, if the Operator is Not Directly involved in the Daily Operation of the
Mine. (Safety Director) - If the
official listed in Item #9 is not directly involved in the daily
operation at this mine, provide the name, title, address, and e-mail address
of the person with the responsibility for health and safety at all of the
operator's mines.� If the official
listed in Item #9 is directly involved in the daily operation, this
is not a required entry.��
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Item #11
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Address of Record and
Telephone Number: - Address and Person designated to receive Official Mail.� Service of documents upon the operator will
be completed by mailing or personal service of the documents to this address.
If P.O. Box or General Delivery is used for mailing address, a separate
street address for personal service must be provided.-Provide name,
title, address, telephone number including area code, and e-mail address for
the person designated to receive official mail.
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Item #12
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This Official Business is
a (check only one box): � Check the
appropriate box that describes the type of business for this mine.� Please do not check more than one
box: Sole Proprietorship; Partnership; Corporation; or Other.
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Sole Proprietorship -A business with a sole (individual) owner. If your business
belongs in this category, please check the Initial or Update Notice box,
enter the Effective Date, and answer �Items 1 through 11 from the Mine Information
Section and Items 12, 14, and 15 from the Ownership Section.� Please remember to sign and date the form.
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Partnership � An association of persons joined as partners in
business. If your business belongs in this category, please check the Initial
or Update Notice box, enter the Effective Date, and answer Items 1 through 11
from the Mine Information Section and Items 12, 14, and 15 from the Ownership
Section.� Please remember to sign and
date the form.�
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Corporation � An association of individuals, created by law and
existing as an entity with powers and liabilities independent of those of its
members. If your business belongs in this category, please check the Initial
or Update Notice box, enter the Effective Date, and answer Items 1 through 11
from the Mine Information Section and Items 12, 14, 15, �and 17 (if
applicable) from the Ownership Section.�
Please remember to sign and date the form.��
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Other -� If your business does not fall in one of the above
categories (Sole Proprietorship, Partnership, or Corporation) this box should
be checked.� Examples of Other are
Joint Venture, County or State Government, and Limited Liability
Company.� Please check the Initial or
Update Notice box, enter the Effective Date, and answer Items 1 through 11 from the Mine Information
Section and Items 12, 13, 14, 15,� and
16.�� Please remember to sign and date
the form.
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Item #13
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If Business is listed as
Other, what is the type of Organization? - If you checked Other in Item 12, identify the type of organization� (i.e.,
Joint Venture, County or State Government, Limited Liability Company, etc.).
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Item #14
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Tax Identification Number
for this Business: The
Identification Number that applies to your Business.� For individuals, this would be your Social
Security Number.� For entities, this
would be your Employer Identification Number (EIN).�� Privacy Act Notice.� We are authorized to request this
information under the Debt Collection Improvement Act of 1996, Title 31
U.S.C. amended section 7701, new subsection (c)(1), which mandates us to
require regulated entities and persons who are doing business with a Federal
agency to furnish a TIN. ��
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Item #15�
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The Individual(s) or
Organization(s) with ownership interest in this Business or Corporate
Officers/Directors -� Please refer to the instructions below that pertain to your
type of business.� If additional space
is needed, please check the box located in Item 15d and attach a separate
sheet.��
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Sole Proprietorship - The name and complete address of the owner (sole
proprietor) of this business.� If
located in a rural area, provide the road name or route number.� Because a sole proprietorship is defined as
a business with one owner, there should only be one owner listed on this
form.�
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Partnership - The name and complete address for each
partner.� If located in a rural area,
provide the road name or route number.�
Do not use the address for the business.� This should be the address for each
partner.� If the partnership's owners
are companies, each company's name should be entered in the field named
Organization/Company Name.� The
corresponding address should be for the office where the company is doing
business (street, city, state, and zip code).�
If located in a rural area, show the road name or route number.� The owner(s) or officers/directors and
addresses for these companies should also be provided.� Please use a separate sheet if additional
space is needed.
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Corporation - The name, title and complete address (street,
city, state, zip code) for each officer/director of the corporation should be
provided.� If located in a rural area,
provide the road name or route number. This should not be the address of the
corporation.� This should be the
address for each officer/director.�
Please use a separate sheet if additional space is needed.
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Other -
�The name, title, and complete address (street, city, state,
and zip code) for each Individual, Business, County or State Government with
ownership interest in the organization.�
If located in a rural area, show the road name or route number.� Do not use the address of the
organization.� This should be the name for
each individual with ownership interest. �If the organization's owner(s) is a
Business or County/State Government, enter the business name in the
Organization/Company Name field.� The
corresponding address should be for the office where the business is
located.� Please use a separate sheet
if additional space is needed.
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Item #16
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If Business is listed as
Other, list the Principal Organization Officials or Members - The name, title, and complete address for each
Individual(s) who is an official or member in the Organization.� If located in a rural area, provide the
road name or route number.� This should
not be the address of the Organization, but the address of each Individual.
Please use a separate sheet if additional space is needed.
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Item #17
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If Business is a
Corporation, please answer the following:
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a.� State of Incorporation - The State abbreviation where the corporation was
incorporated.
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b.� Is this Corporation a Subsidiary? - Check the appropriate box (yes or no).�
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c.� If yes, what is the name and address of your Parent
Corporation? - Provide the complete
name and office address (street, city, state, and zip code) of where the
ultimate parent corporation is doing business. The ultimate parent corporation
is the highest company in the family tree structure with the ultimate
ownership of the operating company. If located in a rural area, provide the
road name or route number.
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d. �Tax Identification Number for this Parent Corporation - The Employer Identification Number (EIN) for the
Parent Corporation.� Privacy Act
Notice.� We are authorized to
request this information under the Debt Collection Improvement Act of 1996,
Title 31 U.S.C. amended section 7701, new subsection (c)(1), which mandates
us to require regulated entities and persons who are doing business with a
Federal agency to furnish a TIN. �
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Signature and Title of
Official Completing Form - The
company official who completed the form is required to sign his/her name, and
provide his/her title at the company.�
This report should be prepared only by an official with full knowledge
of the information requested on this form.
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Date Form Completed� - The date this form was signed, using numbers to show
the month, day, and complete year; e.g., 01/01/2002.� Please note
that this is the date the form was completed, not the date that changes
became effective.
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