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___ _ ,~ <br />~~~ ~ <br />~ '-"-•r. L.-_. ~_ /~ 11 ., <br />- .. - i Wit. (~~/L/~ <br />1_ 1", ~ <br />MINE REPORT '='~ + ~I s <br />Fote--Please fill out this report carefully, write plainly and answer all questions fully. Be sure to <br />date the report and sign it. F, iYlloout ~bot~hf s~id_es Hof (the sheet. <br />------------------- --. _. 19~~ <br />BL"FF 9li Or 7~SIhTES, STATE OF COLOR_~DO. <br />T. r. fienahen, Commissioner of 1lines, <br />Deaver, Colorado. <br />Sir: In accor~nace with Sectioa 4299, Revised Statutes, Colorado, 1908, I suhmit report as follows: <br />\'ame of Compaay-The___________________________ <br />Incorporated in the State of_______________________________________ _ ________-__-- <br />Principal ofSce -------------------------- ----- ___-. <br />c~ca,nrar,r. Capital stock ___________________..__ - _Shares, at <____._____._ pcr shore. <br />EII aut this I Name <br />.wtt: o.aer.i.a ~ P. 0..lddresses <br />i<a•r It Lla»k <br />President __.-._--_ <br />- ---------- <br />------ <br />,Secretary ----- ------------------ --------- <br />;Treasurer ----____-------------- <br />~9fanager - ------------------------------------ ~------~- ------- <br />~'Pitle of Partnership---------- - --- --- -- ---- --- --- ----- --- - <br />! Partm~r~' !~amcs 1'. 0. Address <br />I <br />r. nra: - - ---.. -- <br />ar Uonu.realp, <br />ry'v a:Lenriu~ <br />•• ~u Llauk <br />~fanugcr <br />I Names of Owners ~ I'. O. Addnrasca <br />p+nin+nLly~ <br />f IY Yi! [Lis 'I ~ ~ jL_ _ _ _ -~ r"l/Vk/Yfi~/ V{/ / t~l~L1L '(/a/L`~ ~ ~-~~' ~~ ,~ ~ f -~' I <br />~~//~jA'//.Ai ~'l~ltiucu LSO, /1G(/ I~ Y . <br />y _ _ <br />~_ !11.unager _ ~ ~ - . <br />1~W o~ <br />~'I~'~ nartuas u1' claims: <br />Patented 1'npat~~nicd <br />'ILtLI ::!:rouge patented------- -. aerea; uapatented_ <br />I)v yuu own or lease these clnimsY__ _.. - - <br />ltyou louse Lhem giro name of company or person 1'ruw wL~;m loused <br />IOrer) <br />act•es. <br /> <br /> <br />