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<br />MINE REPORT <br />Note-Please fill out this report carefully, write plainly and answer all questions fully. Be sure to <br />date the report a sign it. Fill out both aides of the sheet. <br />'' I n ,,^~ ~ ~ p /y~ ' - ~ /I~~,/ <br />./V~!~lllulN-'~-i..-- ~ -1_C~,~1~ ---~ Calorndo, ~Q!!_ ~ ~ --------~ 19___ <br />BUREAU OF MINES, STATE OF COLORADO. <br />T. R. IIennhen, Commissioner of ,liince, <br />Denver, Colorado. <br />Sir: In accordance with Section 4299, Revi edStatlutels, ColorJado;J3~-9108, I('submit report ne~7follo s: <br />Name oP Company-Th~~~~!~_ `-' ~'~''~` _1_51L~_L1_ ~~1___1T/_/ v ~4 ~~ <br />Incorporated in the State of______________ ______..________________________________ <br />Principal otI'ice -----------------------------------------------------------------. <br />u . eDmp~r Cnpitnl stock ___________________________ Shares, at $____________ per share. <br />ea °nt tel. Name P. 0. Addresses <br />.wr.; DWerwW <br />kne It bLnk <br />President ------------------------------------- <br />SccretarY ------------------------------- ------- <br />----------------------------- <br />Trensurer ..------------------------------------- <br />\Innnger -------------------------------------- <br />Ir . am <br />nr D.rtnenhip, <br />eli out lhlt <br />rP.ce; othervAw <br />le.vt It bhmk <br /> <br />R oelther <br />amp.n) nor <br />I~.rtnenhip~ <br />All out thl. <br />np.ca <br />'Title of Partnerahip________________________________ <br />Partmn•s' Names P. 0. Address <br />itl6nngCT ________ <br />Names of Owners P. O. Addresses <br />____ <br />S <br />l. ' <br />- <br />--------- l\inaagor__.._- - ----------- ~--- --- ------------------ ----------- -- <br />Shltc nnlnea of claims: <br />_________ % Patented Unpntented <br />orkmea in the !G ~ I~,i ._d,9J--}~=-'=--=3 --~- -j-----~ ~ ---------------- <br />C <br />~'_ <br />------------- _c~s<C~=t----------------------- <br />___ncres; unpnteated________---------- -- <br />'total acreage pntented__ ~1~!----------- .....acres. <br />QompsRY~ ------------------------------------ - - <br />Do you own or lasso these claimal______________-- <br />------- <br />y give name of com any or person from whmn ease ____________-- <br />If ou lease them P <br />-------------------------------------------------- <br />•------------- (Over) <br />~, <br />