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_ ~ ,1 <br />MINE R/SPORT , r,;;i <br />Not~Please fill oat this ren. ..e plainly out. <br />date the report and sign it. T9 ., ~ ,as of tho sheet. <br />~Z.- <br />~~ ~ ,~Od ~ __, Colorndo ~ /3 <br />----------- ------------- ,----------------------- -.19-- <br />BURF.AU OB' 11IINES, STATE OF COLORADO. <br />T. It. IIennhen, Commissioner of 1lines, <br />Denver, Colorndo. <br />Sir: In accordance with Section 4209, Revised Statutes, Colorndo, 1908, I submit report ns Collowa: <br />Nnme of Company-Tho---------------------------------------------------------- <br />Incorpornted in the State of_____________________-________________________________ <br />Principal of(ice -------------------------- -----_ ---- --------------------------.. <br />Capital stock ______________________ -__ Shares, nt ~__________-._ per share. <br />If • Comp.nr, <br />Au not thla Nnme <br />rpecr, otherwW P. 0. Addresses <br />Icavr It blank <br />President --------------------------------------- <br />----------------------------- <br />Secretnry ------------------------------------- <br />'Prenaurer _..------------------------------ ----- <br />\Innnger --------------------------------------- ---------------------------- <br />If a Cnn <br />ar rannrnMD. <br />Ail out thla <br />rparr: otherwba <br />Irm~. It blaok <br />.,Pula of Partnership--------------------- --------------------------------------- <br />Pnrtn~~rs' Vfunes P. O. Address <br />:1lnnnger------------ ------------------- --- ------- ----------~--~----------- <br />Nnmca of Owncra P. 0. Addresses <br />.w i, i <br />i /~JJ~ `- {off, ~~(~/~-y / <br />mquny noY _ _ __ .__ ____ -__ <br />n <br />p;,rwrr~blpp, <br />911 out 411x _..______________________________________-._.. ..________. ________.._..________.._._ <br />•pece <br />-------------~ -;------------- G - - -- <br />------------------ <br />titutc names of claims: ~ `/ ~ J ~~~~~ <br />Patented Uapntcnted <br />g patented---__~t-~ ------------acres; unpntonted_----_----- .._..__--.__ltcrea. <br />Total neren c ~ ---- <br />Do You own or lenso these clnims4__________.._ ---------------------- <br />lFynu lcaso them give nnmo oP company or poreon Yrom ~ehom leuacd___- <br />J <br />~~ <br />i I <br />~~ <br />,, ~ ~j ,~ <br />i i. <br />, '. <br />'I~ I <br />l <br />t. i~', <br />I: <br />i ~, <br />(Over) <br />