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~' ~' REPORT Asa <br />Note-Please fill oat this report catefnlly, write platnly and answer all gneationa folly, Be sore W <br />- data the report and sign it. Fiii oat both sides of the ~h~eet. ~j-~,~ <br />a ~S-aFL/!'Il~ , Colorado /~/ v~' ~ ~ <br />- , -------------~----------~ 19l / <br />RURI~.AU OP MINLS, STAT]; OF COLORADO. <br />T. R. Iiennhen, Commissioner of itlines, <br />Deaver, Colorado. <br />Sir: In accordance with Section 4299, Revised Statutes Colorado 1908 I b 't <br /> <br />II . Comppmr~ <br />IIII nut thl. <br />•r•rr ow.,.w <br />Ir.rc it blot <br />_ au mi repo follows: <br />:Yams of Company-Tha___ _ <br />_ _ ______ __ _J <br />Incorporated in the State of___~ ~ ,/,/.Y' <br />Principal office _______* _ _~f~l/~' t% <br />Capitol atoe)c~L~ _.____..__ Shares, nt $ <br />------------ Per share. <br />m° . A eases <br />President __ _____~__ ,,/~'/~ <br />~ ______ _ <br />_ - Vl! <br />iecretnry ____.r __~ __ <br />-- ---- -------------- <br />f'rensurer <br />-------------- <br />l[annger __ ~ o.Y ' . tnvf,~ ONrf <br />Vii:, <br />'itlc of Partnership________________________ <br />---------------- <br />------------- <br />Pnrtncrs' Names P. 0. Address <br />Unpatented <br />y~___________________ <br />_____ _________________ <br />______________________________________________ <br />If . Crm <br />rr rannmfilp, <br />nu om wl. <br />,P.rr; athmrlre <br />4u'r it Glmk <br />------------------ --------------------------------- <br />------------------------------------ -------------- <br />-------------------------------- ------------------- <br />_________________ _________________________________ <br />______________ <br />________________ <br />lfanngcr---------------------------------- <br />-- -------------------------------- <br />Names of Owaera P. O. Addressee <br />rn nrlthn 1 ___________________________________________.. _________________________________ <br />mrmy nor _____-____'_____ <br />W nnrnahl _________..__ <br />pp __________________ <br />nIl nut tLlr I _______________________ _____ <br />„„n _______________ <br />~1[naager <br />tirrtt~ names of claims: <br />/ , t,. <br />~ _ <br />__ _______ ___ <br />________ <br />Total acreage patented___ _ ___acrea; unpatented___________________________acrea <br />Do you owe or lease these claimet________ <br />If you lease them give name of company or person from ~vllom leaecd <br />i• <br />INE <br />------------------------------------------------------------------- <br />(Over) <br />