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I W ~4 i / ~ i <br />. I / I I <br />MINE REPORT • ` ' ' ~ 1 <br />Note-Please fill out this report carefully, write plainly and answer all questions fully. Be sere to <br />date the report and rilgn it. Fill out both sides of the sheet. <br />~/ ~'~. <br />_if'Z~~-----------. Colorado,-------------------------,19~ <br />BL"PF.AU OF bIINES', ~ST`A~T'E OF COLOR.IDO. <br />T. R. Henahen, Commissioner of lfines, <br />Deaver, Colorado. <br />Sir: In accordance with Seetion 4?99, Revised Statutes, Colorado, 1908, I submit report as follows: <br />. I / I i ~. <br />rName of Company-The_f~f~i~i - -- C~tJ~~y-~~~C~O; <br />Incorporated m t State of-----L/n~~~-- ~- <br />~ I ~ <br />IPrincipnl offic -eQTiZ~ >_'----------- ------------------------ <br />Capital stock __ ~S5_Q_~ _______ _ __ Chares, at ~____________ per share. <br />1! . Cpmpur, <br />en ppt ul. ~ ~ e . 0. Addresses <br />ryacr; pNVwL. <br />' are I: Llank <br />iPresident __ _ ________ _________ <br />ISecreta - - - ---- ---------"--------------- <br />i <br />I <br />Treasurer ------- 'r----------~- ---~--------- --------'•------------------- <br />I <br />;1Sanager - ------'~---- -----4-------='--------- - -------'-------------------- <br />Title of Pnrtnerahip--------------- --------_- __. <br />Partners' \umex P. 0. Address <br />c.nn, <br />er yannmhlp, <br />EI!~ut thb _ _______________ ____ _______ __ _________ ____._ __..___. ____.._____ __..____. _ <br />pu,.; o:Ler.be I <br />log, It blank <br />f <br />~~Dinnager- - - ------------ <br />~ '~umes of O~eucre <br />c pnu,.r -----------~----------- ._ <br />~~~~I~any per <br />y..nu•r..biV. I <br />of m,t tnlr 'I -' -'- "-' <br />~V.~e <br />,plunugei <br />5ta1 ~ names of claims: <br />I'. O. Addresses <br />.. __. __._ ... I <br />., Wllatenteu ~/ <br />acres. <br />es; uuputcuted_. - - <br />1f pt,u louse them gire name of company or person from wham Icused__ <br />- - --- - <br />(Orer) <br /> <br />