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<br />~ If yon have -given a lease to others for all or part of the property, state the names ox tae teeamg com• <br />panies, partnerships or individuals: <br />Name bIanager P. O. Address <br />Ie property tivorked continuoualyt__~}:-_~'~,.______ - --- - - - - - - <br />--------------- -- - ----- -- ----- --- -- <br />If work has been atoPPed,state when_ '---------------------------------------------------------- <br />A`ame, title and address of person in charge of work for you--------------------------------------- <br />- - - ------------- <br />1 -------------------------- ,//J / --- <br />State the character of ore___~~.~~ ~~.t,~ -=~' ~ ------- <br />State the value of the ore____.~ ~-:~____-- ---=-G-==-/_ f2=---~ ='~ -------°'----------"' <br />' MEN E)1f YLOYED <br />' No. Employed No. Employed <br />~ ____illnchine Drillmen, $______for____hourahift. _____Engineers, _ _ _ $______for____hourahift. <br />'' ~___Afachine Iiclpere, $______for____hourehift. _____Pumpmen, _ _ $______for____hourahift. <br />~ _~: _Dlinera, _ _ _ $______for_: hourehift. _____Firemen, _ _ _ $______for____honrahift. <br />___ _Timbermen, _ _ $______for____hourahift. _____Blacksmitha, _ _ $______for____hourehift. <br />~ _____Trammera, _ _ _ $______for____houraliift. Teamsters, _ _ _ $______for____hourahift. <br />~ ----- <br />_____Oro Sorters, _ _ $______for____hourehift. _____Foremen, _ _ _ $______for____hourehift. <br />;; _____Tapmen, _ _ _ $______for____hourshift. _____Superintendent, _ $______far____honrehift. <br />i _____Lnborera, _ _ _ $______far____hourshift. _____Otfice help, _ _ $______for____hourehift. <br />_____Asanyers, _ _ _ $______for____hourehift. _____llfillmen, _ _ _ $______for____hourehift. <br />_____Electricians, _ _ $______for____hounahift. _____~Vntchmen, _ _ $______for____hourshfft. <br />~ ________________ _ _ $______£or____hourahift. ________________ _ _ $______for____hour shift. <br />` Average number of m~e~n employed this yenr_____r~______________________..______________________ <br />I' Ia there n mi114---"-"------------------------------------------------------------------------- <br />i;~ ~ N¢mc of mill-----------------------------------Location of mil1--------------------------------- <br />I Char¢cter of mill------------------------------------------------------------------------------- <br />Capacity of mill_________________________________When was mill erected___~'__ _~D ___ <br />(}ivo lipt of builcJ~gs, trnmrvnys and other surface improvements _____~/~'s1_~~t~_ <br />____J___~S ~~_/'_~2'L____________________________________________________________________________ <br />Coat oP surface improvements made is 19~j` ._ _ _ _ _ _ _ _ _ _ $__~~ '_'___________-. <br />State amount and chnrneter of underground development:. <br />Tatnl Development <br />~( Shafts -----------------------------ft. <br />Drifts __:Y_//~~rU~_--°-------------ft. <br />Crosscuts I!_t~i________._°-_---____Yt. <br />Amonnt Done in 191) <br />____________ft.; coat per ft., $__________ <br />.v ~-. <br />____________ft.; cost par ft., $_.{:_______ <br />ti~ <br />____________ft.; coat per ft., $ _ ____ <br />Yt!,. <br />____________ft.; coat per ft., $~1_______ <br />$ave you roported to this department all fatal and non-fatal accidents/ ~occu ~,7Rg7 to workmen in tha <br />twelve month~~~mg the/gate/a~~ this rgport, ae regni d bye lawt _1f'~i~l.Y_~~3_zF~___________ <br />7temarka:__~~!F!_JZ~7.:~~f-G2._!C_['~~-!~ _ fQ~,j~lfl~~___L_111w~X.ft:5~„--___ <br />___________________________ <br />_ _ _____________________________________________________________________________________ <br />_______________Y ________________________ _ <br />_________________ ___ <br />Signed ~__~~~jQ~~!tf=i_r---- Company. <br />Title-_--__-- <br />