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names of the leasing com• <br />Q. 07.a7rlrwv <br />ivesber 19, 1. „ <br />.anal <br />~VO <br />}38 <br />nor <br />:nts <br />~r <br />he <br />~~. <br />MINE REPORT <br />Note-Please fill oat this report carefully, write pLiinly and answer all questions folly. Be sere to <br />.date the report and sign it. Fill oat both sides of the sheet. ~~~~~~ <br />-_~~iiF~_rI____________________, Colorado, _c!J_!~1l'__~~__, 19Lg <br />.\ - <br />_. e~ , <br />In accordance with Section 4299, Revised Stntutw, wlor:- .. ,:, , <br />Name of Company-The- _ __ ~ _-QY_-~! -- <br />~3~~~ %~.t, ~--P-~p~ ---------------- <br />ncorporated in the State of_________'__/__,__,(_/__/__~~_~________________________________ <br />~ Principal office _ . .. .J~C~L~.._S!!C__ _ <br />Capitol stock _________________________._S)tnres, nt 9;____________ per elmre. <br />a <br />„y, _ T me ,~,~,/ ~~~~ ~/ ~ ~P". O. Addresses <br />President _ _ __..____ _ ______ __ ! ~~/_~~~~1_<n~ <br />/ Secretory <br />,Treasurer ------------ ------------------------- ----------------------------- <br />of Pnrtnership-------------------------------------------------------------- <br />Partners' \,unes I. 0. Address <br />. Erm <br />1lnnuger-------- ------------------ -------------------------------- <br />Names of Owners P. O. Addressee <br />s of 111nea . <br />II neither <br />cumpm) oor <br />p~rUmnhfpp, <br />all out lWi <br />•y~tt <br />~I6n6{'eC__._____.._______________________. ____ __________________..______________ <br />State names of claims: <br />Patented ~~ ~~ Unpntented <br />------------------- / 'Total acreage patented-------------------------acresntented__--------------------- ---ucres. <br />-~„~~-._„~(rppy~~, `'/Do you own or lease these'claimst_ -~'~---------------------------------------------- <br />------------------- If you lease them give name of company or person from rvltom lensed__________________--------____-- <br />----------------------------------------------------- <br />------------------- (Over) <br />