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t~Y i <br />) <br />MINE REPORT '` sky `~ <br />Note-Please fill out this report carefully, write plainly sod answer all questions folly. Be sere to <br />date the report and sign it. Fill out both aides of the sheet. <br />~" ~ <br />---•--_/_ ~-~~/_~_--, Colorndo, _S _.L!Ef_-~1-(~-1--_--. 191 <br />i3URPAU OF MINES, STATE OF COLORADO. <br />T. R. I3ennhen, Commissioner of iitinca, <br />Denver, Colorndo. <br />Sir: In nccordnnce with Section 4299, Revised Statutes, Colorndo, 1908, I submit report as fallovvs: <br />Nome of Company-The-------------------t----------------------------------- <br />Incorpornted in the State of_________________ o~___/~-_________________._______ <br />Principal office -------------------------- ---.,-~4~~~I'L-~Z-----------------.. <br />Cnpitnl etocl_ ___________________________Shares, nt 4_____~____ per share. _` <br />If • Camp~n), <br />011 nut t b Nome P. 0. Addresses <br />,yore; otherwW <br />Im.r It bunk <br />I'reaident ----------- ~------------------------ ---------------------------- <br />Secretnry --- -------~------------------------- ----------------------------- <br />'prenaurer -----------'L------------------------- ----------------------------- <br />~Jlanngcr ----------~ -------------------------- ----------------------------- <br />If . Orm <br />nr pvrtnrnhlp. <br />011 out tbb <br />gwre; otherwbe <br />Invr It bLnk <br />Title of Pnrtnerehip-------------------------------------------------------------- <br />Pnrtners' X;unes P. 0. Address <br />i<innagcr------------ -------------------- -- <br />Nnlnca of Otvncra <br />If nelthrr <br />rninYVn1 nor <br />partnrnbi y <br />ral aut tL~n <br />goer <br />._ <br />--- - <br />f~ <br />//'' ~~P. O. Addressee <br />__(.LS<LGtity _~------------- <br /> <br />tilntr, names of claims: <br />Patented Unpntentetl <br />-- --------------------------------------- _~~~x~~ ' -~--~-~~~T 2 <br />-- ----------------------------------------- --p L~C~>~~ ------------------------ <br />-- ------------------------------------------ ---------------------------------------------- <br />'fotnl Herat a __-------_-- - --arses; uupatented__-------- -----.. YQ- --nerea <br />g patented________ <br />Do you own or leneo these clnime4--------------- -----~~~----~`~-"1_i~--------------- <br />lf you lease them give name of company or petBOn Yrom whom lensed____-.-.________-_-- ------------- <br />-- - <br />(Over) <br />~, 1 <br />!i <br />~~ <br />~, 1 <br /> <br />