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J ~. __ ~ ~/ -- .. - ----- <br />of the leasing com- ~ ~ <br />MINE REPORT l ~ ~' ' <br />). Addspss _ <br />---. <br />Note-Please fill ant this report carefully, write plainly and answer al] questions full <br />-°`-'°--------- date the report and sign it. Fill oat both sides of the sheet. <br />y. He sure to <br />------------- - <br />------------------ <br />---------------------------------, Colorado <br />------^-------- ~ ------- ---------- -, 19--- <br />------------- <br />ifirCJ ---- <br />for____ttegrshift. j _ _ `~ ~ n /~ <br />Por____hour shift. ~ ~/l~~(~~ /~' ~ ~~ <br />!or____hourshift. / / ~- ~ / G'~ ~~~y ~ / <br />for____hourshift. `~'~/ ~--~~ <br />for____hourshift. ~ Ut/ _~1_-- uA l ~~- <br />for____hourehitl. ~ /~ ~ -C ('t <br />'or____hour sl~itt. j <br />'or____hourshift. L <br />or____hour shift. ~' J <br />~'L L-[~C Cc-U <br />or____hourehift. ~"v/tG~-~-~ ~~/'f t-v <br />or____hourshift. "q / ,,/ <br />' ~z~ ~~~ <br />,, _ <br />~~ ~ti~~-mil ~~e~ 4 <br />/~ _ _ ~ D <br />~ r ~ ~ ~/I~e t C Gt~ ;~~ /~ <br />______________ ~/~ // ~-^-~•~, it ~-l~ ~ [%~y(/V ~2iC 4-U( <br />~- '~/t-C l-. ~ ~ ~ _ 1- ~ X11' n <br />ti- ~c'`-~-~-~- ~lc~ ~ ~,~g' ~--.' <br />-~ ~ ,~ ~ ~ . <br />-- ~---- <br />~--- - <br />~~.~-- <br />fkme~ n in <br />----------- <br />~AipaAY. <br />~„g~1~[ <br />vv._ <br />~ .~ ~..e ~ <br />~`~~ ~~ <br />~~ <br /> <br /> <br />~ ~~ z~-~ <br />T~,tal acreage patcutcd-- <br />--------------noes; unputented_______ ---_-_ -_ acres. <br />Un you otvn or lease these elaimsi_____________ <br />if cuu Icuse them giro name of company or person fran whom Icnsed___ - .- <br />(O~~er) <br />~. <br />l~ ~~~ ~ .~ <br /> <br />1 1 <br />1 t <br />~~ <br />I ~"'1 <br />