MINEBK00175

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

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MINE REPORT i~~ ., , ,
Note-Please fiB out this report carefully, write plainly and answer all questions fully, eB sure to ~
date the report and sign it. Fill out both aides of the sheet.
_ 4~.,t.)_. Colorado ~
------- -- - - t ------- \~~~--------, 191,-
BtiRF.9ti OF '_1fINES, STATE OF COLORADO.
T. T. Henaben, Commissioner of .lfines,
Denver, Colorado.
Sir: In accordance scith Section 4299, Revised Statutes, Colorado, 1908, I submit report as follows:
rName of Company-TLe___ _-- -------------___----
~Incorporated in the State of__~,~____.______.._______________________.__-______
,Principal of5ce -- ~ - - ---`-- ---- --- ------ --------------------------
o0
Capita] stock ______5_Q-~:Tc~!R_.. _Shares, nt :$___i__~__ per share.
I! t Cam wr, I
n: °°° ~'' ~ Name P. 0. Addressee
i..,t It black
President ~1~i.vv.~_~-i~s~. - - ----- -----]_Q~,¢~------
Secretary --- - --- - -- - ---- ---- --------- ~~---------
ITreasurer ---------U--------------------- ----- ---------- ------------------
~, Manager ~?i~~c-- - ------------- ~ --- -- -- ~-
(Title of Pnrtnerehip_______________ ______________
~ Partn~•rx' ~am!•x I.O. Addres.9
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DII UVI [lut __.._______________-__. ___. __-- ____. _- - _ _ _ _ __ _ _
ryv.~. U:WrriM ~ - _ - ... ..
Im.. It biu~k _______
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~~lnneger__-_. ._ _ .._- -_--_--"_.
Nimes of Owners
P. 0. Addrennex
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pV •~U.,Xb I°,
c[ou: tau .-'-_._-_-_.-__._-__'_.__ _ _
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I` 51.unugrr .
Vi'e' uumen of cluimn:
Putrntrd
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'fotbl a~•rruge pntrnU;d__ - .- - _ncrrn; uJlpatrnted_
llo yuu own or !cane these claimaT_co-xA.J*>9~ - ~- ~ -
(f yuu leuae them give snare of rumpany or prrnon frow wLum leaned
rover)
IJnp:rtrnted
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