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Producer s Utah account number 4. Recipient s federal EIN (or SSN if an individual) 5. Utah mineral production gross payment to recipient 6. Utah tax withheld on mineral production 7. Utah mineral production gross payment not subject to withholding 8. Recipient's name, address, city, state, ZIP code 9. Recipient entity type (check one) C - Corporation S - S Corporation I - Individual P - Partnership L - Limited Liability Company O - Limited Liability Partnership T - Trust, Estate o.

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