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~''? <br />/ ~ ~, <br />-std ~G1~-'1C~ ~4 ~ i : ,. <br />.; ~:~~ <br />~~ MINE REPORT <br />No e-Please 8ll ant th <br />date the~eport and aiga it. <br />BUREAU OF i<1 <br />T. R. IIennh <br />Denver, <br />Sir: In acc <br />Principal ofTice _ ___ <br />Capital stock ____ ____ _____. <br />C <br />President __ _ _ _ <br />Secretary _ _____ __ ___ ___! <br />Treasurer ____L__________ _ <br />1lfanager __-------~---~---- <br />the State <br />If ~ Compaa), <br />711 salt b <br />rp¢r; athenrW <br />lore It hl.ak <br />If .arm <br />ar O.rtarnhlp, <br />IIII out lM. <br />.Mee: ather.W <br />le.re It bLak <br />If nelNer <br />rnmMnl nor <br />partnm6lp, <br />..".II out thin <br />"Pa <br />STATE OF <br />nmj@sioner of <br />oP <br />of <br />t carefully, write plainly and answer all gneationa fully. Be ante to <br />nt both aides of the sheet. ~~~~ <br />-~ ----------------~ Colorado, -----------'~~~-C------, 19~i.~ <br /> <br />Statntea, Colorado, 1908, I submit report as follows: <br />------------------------------------------------ <br />__------- Slmrea, nt $____________ per share. <br />~ P. O. Addresses <br />----------- ----------------------------- <br />----- ------ -- -------------------------- <br />t P. 0. Address <br />Sinnnger------------------------------------ -------------------------------- <br />Names of Owners <br />Inna¢er------------------------------- ---- <br />State nnlnes oP claims: <br />P. O. Addresses <br />Patented Unpntented <br />'Ibtal acreage patented_________________________acres; unpatanted______-.____________--------acres. <br />Do you own or ]ease these claimei--------------------------------------------------------------- <br />It you tense them give name of company or person Yrom wlloin lensed________________________--____-- <br />--- ------------------------------------------------------------------------------------------- <br />(Over) <br />