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/ ~ :;,~iz <br />e leasing sum. MINE REPORT <br />dress Note-Please fill oat thfa report carefully, write plainly and answer all questions fully. Be earn to <br />date the report and sign it. Fill oat both sides of the sheet. <br />------------- <br />_4-y r_s__G_____, Colerndo, __ ~. ti2_-'= ~~ ___, 19~ 3 <br />[3tiRPAU OF i<iINI;S, STATi; or' OLORADO. <br />------------ T. R. Aenahen, Commissioner of llinea, <br />_-__________ Denver, Colorado. <br />____-______ ~;.~aJair: In accordance with Section 4299, Revised Statutes, Colorado, 1908, I submit report as follows: <br />If a Compvo), <br />nn out t 1. <br />.voce: othetw4s <br />Lars It blank <br />Name of Company-The---------------------------------------------------------- <br />Incorpornted in the State of------------------------------------------------------ <br />Principnl office -----------------------------------------------------------------.. <br />Capital stock ______________________.-____ Shares, nt ~____________ per share. <br />Name P. O. Addresses <br />President --------------------------------------- <br />Secretnry --------------------------------------- <br />Trenaurer -------------------------------------- <br />\fanager --------------------------------------- <br />~~ <br />v . erm <br />r rar[nenhlp, <br />NI out lhb <br />[pure; otheMae <br />leore It blank <br />/~P'artner-' \nnres <br />--- ----~- - -- --- --~aJ~-1'_-- <br /> <br />. -( <br />---flf-tom <br />~'~. 0-~ A~d~dress <br />__________.~.._______________aa -.___ <br />Names of Owners <br />I! udther <br />~~mp.~) Opi <br />vnnenhip~ <br />IIII out tuL <br />gaee <br />P. 0. Addresses <br />--------------------------------- <br />:nnaaer------------------------------ ---- ------------------------------ -- <br />Sinte names of claims: <br />________ Patented ~~- Unpntented <br />rkmen in the _ y-.a..~-a--- ---------------------------------------------- <br />------------------------------------- <br />------------ -- - -- - - -- - ---- --------- <br />---~~s~r..~s - ------------ <br />------------ <br />---------- <br />------------ ---ueres. <br />'I'oL•11 acreage patented-------------------------scree; unpatente _________-------__-~-- <br />_--Compen~. Do you own or lease these clnimsf___~y~~= -~--------------------- ------------°""-" <br />if you lease them give name of company or person Yrom whmn Iensed_ r o N ~~ <br />