Each person engaged in mining coal must, on or before March 31 each year, file with the department of revenue a statement of the gross yield from each coal mine owned or worked by the person in the preceding calendar year and the value of the coal. The statement must be in the form prescribed by the department, which may be coordinated with the form used under 15-35-104 and must be verified by an officer of the firm. The statement must include:
(1) the name and address of the owner or lessee or operator of the mine;
(2) the location of the mine;
(3) the tons of coal extracted, treated, and sold from the mine during the tax period;
(4) the gross yield or value in dollars and cents derived from the contract sales price as defined in 15-35-102.