U.S. Department of Interior, Office of Surface Mining Reclamation and Enforcement


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Please explain the changes to your original filing on the back of this form.-
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Approved by OMB, no. 1029-0063. Expires 7/97
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Amended OSM-1
Coal Reclamation Fee Report

Use this form to change an OSM-1 report already submitted.
Send this form with any supporting documentation along with
a check or wire transfer for applicable fees to:

indent Office of Surface Mining Reclamation Enforcement
P.O. Box 360095M
Pittsburgh, PA 15251



Reporting for
Mater Entity number
Permit number
MSHA number
Mine name
State
Contact name
Telephone number