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' ~ oIInty~~?i>,C. ~~ ~ . ~ . <br />1 of the leasing eam. MINE REPORT `~- ' <br />O. Address Note-Please fill out this report carefully, write plainly and answer all questions folly. Be sere to <br />_____________ data the report and sign it. Pill out both sides of the sheet. <br />---------- _ --- - - ----------------+ Colorado, -- ---- ~---~` -----+ 19x1 <br />_ _ ___ BUREAU OF 11IINE5, STATE OF COLORADO. <br />----`-`- T. R. ]3ennhen, Commissioner of ,Hines, <br />~~~~~-l~l ? Denver, Colorado. <br />'----"-'-------- Sir: In accordance with Section 4299, RovisedStatutes, Colorado, 1908, I ~ubmi't re~po'rt/n~s follo~wJs: <br />2__ -_---------(,~.. Nome of Company-The--- ` ~~~~~'V.r1~"~ _.-(ir _ <br />L_sA%Lt.~/_.v_/_y__<i Iucorpornted in the tats of___~~ <!_`"G~r~~ _!--'_ _________________________ <br />o i <br />Principal oftino __ ______ <br />Ir.cnmp.nl. Capital stock ___________________________ Sltarca, at ¢____________ Per share. <br />ell •.' tbl. me P. 0. Addressee <br />_for_ ~}IOUr shift• / <br />~ :` ~ i~ n :M" /~j~~[~Y r ~~GTi 1'Z:~/~ljGc~C~ J <br />._for____hourshift. President _ _ _ _ ___ _ __ - _ _ _ <br />.__`or_ __ _hourshift. <br />Secretary --------------------------------------- ----------------------------- <br />_for~lloursllilt. Treasurer __________ ----------~-------------- <br />y~ ---------------------------- <br />_for____hourshift. Manager _U"~2~~Qf ~~~4%r%~~~~~=~L-- --~~~-----~~-~ <br />_for____h ursllift. <br />~for___.I'lour Tit. Title of Pnrtnerehip-------------------------------------------------------------- <br />_Cor__-_hour shift. Partners' Humes~/~~~ P. 0. Address <br />_for----hourshift. ---- -----------~e~~~~~XiS,!f[//«c''%r; ----~-~--~--y-~--~/-------~ --------g--- <br />_for____hourshift. _ _ _ _ ~!f!4~``!=4!<-~!!~'jt_fj_~•~ <br />-- -- - -- --- <br />If .eon <br />_for----hourshift, nrv.nn.nmv. - ------------------------------- <br />IIIlauttbl• ________________________________________. ___ <br />goes: otherwlw <br />lease It blank <br />7i^G <br />- - Dfanugcr------------------------------------ -------------------------------- <br />---------- - -- Names of Owners P. 0. Addresses <br />If nellb<r ______________________________________.._ <br />-- ----- <br />_______________ comV•nl nor <br />n.rtnmhiyy, ______________________ __________________ __ ______ <br />________________ all out tnL ~ ~~ <br />•V•n <br />13 <br />$------ <br />~-..------- Ohlonager------------------------------ ---- ------------------------------ -- <br />$---------- Stute names oP claims: <br />$-"_--'--- Patented Unpatented <br />workm n in the <br />---- - ---------------------------------------------- ---------------------------------------------- <br />--------------------------------------------- -------------------------------------------- <br />--------------- <br />------- O ----- <br />'Potul acreage patented-------------------------scree; unpatented_____-------------- - _..___scree. <br />L~_=Company. Do you own or leaso these claimaf-----------------------------------°-"--`---`-----------~-- <br />-~ <br />3~Cf~ ___ !f you ]ease them give name aP company or person from whom lenaed-------------------------------- <br />---------------------------------------- <br />(Over) <br />