MINEBK00175

• County: Lake
• Document: Manager
• Suffix: A

ng com~
in the
mpany.
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RLR1::1II OF IIIhES, ATE OF COLORADO.
T. P,. Hennhen, Commissioner of lfines,
Dearer, Colorado.
';ir: In accordance with Section 4299, Revised Statutes, Colorado, 1908, I submit report as follows:
MINE REPORT
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Note-Please fill oat this report carefully, write plainly and answer all questions fully, Be sure to ~ ~ `
date the report and sign ' Fill oat both sides of the sheet.
Game of Compaay-The------------------------- -------~------------------------
~lncorporated in the State of________________________________________-__ ___
~iPrincipal office -------------------------------- ----- --------------------------..
,Capital stock ___________________-_.._- _ Shares, at b------------ pcr share.
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ec cv: mb ~I Nnme P. O. Addressee
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'President ------ - ------- --------- - ---- --------------------------
~Secretary --- --- - ------------------- --- -- -- ---------------------- -..- --
Trensurer -------------------------------------- --=----- ------- - -------
~'Slaneger ------- --------- - ---
('title of Partnership---- --- _- _ ~! ~°~-<u__ _ -.---------
Partn~ "'^nn~~ Address
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Jfanager i "L: a v = - ---
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!1:unea of Owners
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M1tanagcr-- - -- _ -- - ----..
~tat~. ^:nucs of claims:
Patented
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1'. O. Addresses
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'lbtul ucn:a e _ acres; uapnteated__-_- ----
B Patented---------- ------- - -- -
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Do yuu owe or lease theao ciaimel___--
uY"u se them give name of company or person frgq,tlq whom leaaed__
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- Over)