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GoIIntyG~ ~1~ .~ <br />~is~i; <br />aaing °em. ..MINE REPORT ,; ~ ` <br />a Note-Please fill out this report carefully, wn and answer all questions fully, Be sure to <br />___.._.-.. date the report and sign it. Fill out both sides of the aheet• <br />--- <br />-- ~~ -, colerado,~~-_2.2`~`f <br />- BUREAU OF' b1INES, STATE OF COLORADO. <br />T. R. Hennhen, Commieaioner of 1linea, <br />'------ -- Denver, Colorado. <br />'_____"__- Sir: In accordnnco with Section 4299, ReviaedStntutes, Colorado, 1908, I submit report ne follows: <br />a ~e.oo <br />hour shift. <br />!lour shift. <br />your shift. <br />'lour shift. <br />lour shift. <br />lour shift. <br />lour shift. <br />lour shift. <br />lour shift. <br />lour shift. <br />IOUC 8111ft. <br />It . Camppavr, <br />fill avt thb <br />luo<~ .tn<r.b. <br />~a,-< it hlNt <br />1(• Orm <br />r ~ortn<rehip, <br />fill t tub <br />p4[<: OlncrMlN <br />Our. It hlsnk <br />Name of Compaay-The_________________.._ <br />----------------------- ---- <br />Incorpornted in t11e State ot______________,______ <br />---------------------- <br />Prineipnl office __________________________, <br />----------- -- <br />_______________ <br />Capital stock ________ _._Shnres, nt :$________ <br />Name ---- Pcr ehnre. <br />P. 0. Addresses <br />President -- -------------------------------- - <br />-- -------------------------- -- <br />Secretary __________________.,_ <br />------ <br />Treasurer ------------------------------ -.- <br />-'- <br />)Innnger _._________._ <br />---------------------- <br />_-T- <br />t O <br />'1`itlo of Partnership____ _~___~___ yG~ _SC/pr._.____ ___ <br />n PartRl•I'S' ~nnr'e v I'. O. ,lddress --- <br />- .- <br />--c7'-~ _~- _ _ __ -t---- -- - --- <br />________ <br />_____ _ <br />Binnagtu•___-----._---- <br />--_.-.-- ( Names of Owners P. O. Addresses <br />i <br />-Severed - ---------- <br />s _end_ ------ ------------- <br />- ------------ <br />_ ^nriW<r ------------------------ <br />______ .muPany n0< ___________... - <br />_ _ _ _ _ _ _ _ I~.vturtrhlp, <br />sll out tole - _ _.._______________________________________ <br />•1'ace _ __________________ <br />_____. __ <br />____ I _ <br />1 llnnngnr__ _. _ <br />~ val~• n:unes of claims: <br />---- <br />Patented Unputenten <br />n in the .- <br />~lJc `~~t~u~ ---°hd--~l`-~'-° ------ <br />and <br />'fohll ncreuge pntented_______~ Q________--"--- acres; unpatented__ ____ ______----~--__----~ucres. <br />ompany. Do you own or lease these clnimst______7-e.~i-Gt_ <br />-------------------------------- <br />._____-- If y"It tense them i~•e Hume of company or person Yrom whoru lensed_ <br />1__L ~ __ ~ <br />%~qr~2 t/ (Over) / <br />