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~i <br />~~ ~ ~ i <br />Laing Dam- ~ MINE REPORT , '- : ~j <br />Note-Please ftll out this report carefully, write plainly and answer all questions fully. Be sure to ~ <br />date the report and sign it. Fill out both sides of the sheet. <br />--- - <br />---- ----------------!ye:d;a]..'reT__. Colorado, _1i0.~~^bi'S'_ i ~' t9]~• <br />aQ i f~~ BL'.. <br />~'"`~(y Deaver, 1, <br />__ __- Sir: In accordance with Section 4?99, Revised Statutes, ^_olarado, 1908, I submit repur. „_ <br />p _____ _ Incorporated in the State of-------------- ------------------------------- - ----- ` <br />_"" "L ~ 1 <br />~-----Principal ofiice --------------------------------- --- --------------------------~ <br />Capital stock ______________________ - _ Shares, at $____________ Per share. <br />u . c.ln~.vr. ~ - - - <br />m.n•` ytt1GR[IM i~'nme P. 0., Addresses <br />.our shift i[,[[ a m.nk <br />President ------------------ ------------ ----~----------------------- <br />onrshift. <br />(Secretary --------------------------------------- ~= /------------------------ <br />onr shift. <br />Treasurer -------------------------------- ----'~/ ----------------------------- <br />onr shift. <br />onr shift. ~`'tfan¢ger ----------------------------------- -----------------------_ _-- <br />onr shift. <br />(Title of Partnership---------- --- r --- -------------------------------- -- --- <br />onr shift. <br />onrehift. ~ Partners' Sluucx ,~ Y. 0. Address <br />I ~ _ _ _ _ <br />Dllr shift. ___ _ _../~__-_________. _.._ _ <br />Dnr xhlfl. u., nml / _ ____________ _.___ __ ___.___..__ <br />n,rtn•n61y, <br />onrshlft. ml~m wl. ----------------- ----- --- ------ --- -- -- - --- -- -- - -- -- - <br />I[n• It LLnk <br />_____ _ / <br />______ r Names of Owners P. 0. Addresses <br />~I !~V -U.G ['"'....rll .p . .1Y['71. -. - _. _.. _ LCJ,._ ')rl.,. :1.- V •- - - _ _.. __ <br />.--_____ ~ -_..~J. .. _.._... <br />_____ <br />'_ iu~i:^?.-~i;l•L'!t.~~ _~=.(J F:~__. _. .______._ ,~f_~_1c r.U, l~T• .- 1 <br />.... , .. ., 1-~ <br />~~ 1~[la~[[ ~ L~S_,. l_~!l• _. i_i J! 1 , .._ _ Ji~2_-.<I.~, <br />• rniruT nm p <br />_ _ ___ _ _ _ <br />~__-_-_ n~nurnhiY~ JAI-x)';C _.~1°:: f']_. _ih.:~t•~.Z r'~~'~1: _'ISLZ' 1,~J-F:.. ~'~IZC.!L !.l'_ ._. _._ <br />::: 4111 LJ JR • ~ <br />•p,tt <br />_ _ - <br />JTuuagcr_.IJoLe.-.. _''. ;a:ie;lfl,- 1~CLt, Lh;_~.'11:e,..C~lv.- <br />pD '~<':d~: numbs of eluims: <br />--- Patented -J;¢patenGeu <br />I <br />. in the Pl.~JTC.AV.a --- -- - - -.~L.::T%. ._ _. _ - - --_. - .. - <br />------ <br />, <br />------ )1.rL-12j~.1-!:LL'1L1L -~Ii.L'^L -. .._. <br />-Ja B:2L f1T_ -- --------------.. - <br />------ J:ew Ue1Lb-------------------------- - _ <br />_IiJ ucrex. <br />' r _. -_.acrex; unPatented_ - <br />9btal acreage pxteutt,d___~~.-.'L :,C -- <br />_ l <br />~~ uDYuuownorleasetheseclaimxt____ _- - - --- --- ----"" ~ ~~ - -~~ ---- - ~ <br />If po^ lease them give Haute of eoulpuny or person frmu wham leased-_ -- + <br />------ _ 1 <br />-- - i <br />_-_ .. - <br />_---- - <br />----° (Over) ~ l <br />~ i ~I <br />4; ~, I . <br />