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~~7~ ~/ ~ , I'I <br />MINE REPORT .~n~>. ' <br />P1 fill t this <br /> <br />Note- ease on report carefully, waste plainly and aaswer all questions folly. Be sere to <br />date the report and sign it. Fill out both sides of the sheet. ~p ~ ~ <br />----------~S~J~LLL1!L-~.i----__-. Colorado, ----~4T~=S-.---~-~--, 19 ~_~ <br />BUREAU OF I<IINES, STATE OF COLORADO. <br />T. R. Iienahen, Commissioner of 1lfinea, <br />Denver, Colorado. <br />Sir: In accordance with Section 4299, Revised Statutes, Colorado, 1908, I submit report as follows: <br />Name of Company-The---------------------------------------------------------- <br />Incorpornted in the State of______________________________________________________ <br />Principal a(Hce ------------------------------------------------------------------ <br />Capitnl stock ___________________________ Shares, at $_______-____ per share. <br />If a Compaorr <br />ea °°t tt[i• Nnme P. 0. Addresses <br />rpate• othenAw <br />lave ie mgt <br />fitlo of Partnership-------------------------------------------------------------- <br />Partners' Namns P. O. Address <br />-------------------------------------------- --------------------------------- <br />II . erm <br />or pannenhlp, <br />OII out thh <br />[parr o[harwla° <br />leave It black <br />i1IADagCr____________.._______________________ <br /> <br />It orlWrr <br />r°mpanr oor <br />partnenhly~ <br />NI out Wia <br />aspen <br />President --------------------------------------- <br />----------------------------- <br />Sccretary --------------------------------------- <br />----------------------------- <br />Treneurer ----------------------------- <br />-------------------------------------- <br />11lnnnger --------------------------------------- <br />----------------------------- <br />Names of Owners <br />------------------------ ---------------- --- - <br />____________________________________________ <br />~IBnageC_______________________________-____ <br />Stntc names of claims: <br />P. O. Addresse~ <br />_________________________________ <br />Patented LTnpntented <br />j <br />---- <br />--------_--------------- --------------------------------- <br />il~ i .[~• <br />-- --~`-=s---=- =----=------------- ---------------------------------------------- <br />'t'otal acreage patented_____~ Q_______________acres; unpatented_________________----_-._---acres <br />d - <br />Do you own or leneo theeo claimsT______.<c.---~h~J2_1----------------------------------- <br />If you lease them give name of company or person Prom whom lensed________________________________ <br />---------------------------------------------------------------------------------------------- <br />(Over) <br />