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L ~'~~~ <br />MINE REPORT ~~=~ ~ ~ '~ <br />U ~, 1 <br />Note-Please fill out this report carefully, write plainly and answer all questions fully. Be sure to <br />date the report and sign in Fill out both side; of the sheet. <br />_ ~.~-r=rr~-ems-sue----------. Colorado, -- ' _---'~~---- 1-_. _ ., 19__ <br />BL'FF.ati OF AiINES, STATE OF COLORADO. <br />T. 1:. Ilennhen, Commissioner of _lfines, <br />Denser, Colorado. <br />Sir. In accordance with Section 4299, Re~~ised Statutes, Colorado, 1906, I submit report us tollo~es: <br />I: ~ Comyan!. <br />GI'. vu: tldF <br />MR: U:ht'R:aa <br />Ip.r It Wunt <br />r . n.m. <br />': tUenumhly, <br />.A ~! 'LI, <br />1: Lout <br />1• n.u~u, <br />r„.~,...c~n. <br />tf. ur. tw. <br />.i.,. <br />~tinme of Company-The------------------------- ----------------- ----- <br />~,Incorporated in the State of______________.______ _____-----_--------------..____-- <br />IPrincipal office -------------------------- ---- --- ------ ------ <br />- -- --- <br />',Capita] stock _____________________ __ _ Sh::res, at $___.. per share. <br />------- <br />I Nnmc P. O. addresses <br />'President ----- ---------- - ----------- -- - - ------------------------ -- <br />~3ecretary ---------------------- - _ --- ------ - - ----_ -- -- <br />'Treasurer ------------------------- --- - ---- - --- ----- - -------------- <br />Slunager -------- -- <br /> <br />---------- ---------- <br />------ <br />- - <br />- --------------- -- <br />/ ~ <br />( <br />' , <br />~ <br />` <br />"~ <br />`~ =?~!---^-~ <br />(Title of Purtnerehi ~ <br />p-----J--- - - -'~ <br />-----~---- - <br />- <br />--- - --- <br />P rtners' ":onus <br />! li P. O. Address <br />-- <br /> i <br />~- ------'~'---T- -- ._.--~- '_~' - --- - <br />/~ <br />- - --- -- <br />~ ~ <br />1 <br />~ _ _ :. _ <br />7 <br /> <br />~___-- - __j-I__. / _ _. <br />r ~ Nmnes of Otie~rs <br />-c._=.-r.-(-.•-.i•~ _. ice; ~,- .. _~ <br />a `~ <br />,Anna ~!r._ - - <br />- ~uel~ n::umn of cluitns: <br />Putcnted <br />n the % <br />- , / <br />--1 mot. -~, ~_ ~ <br />1'. 0.:lddresses <br />1'npatl•nted <br />------------- <br />'futal a~~rcugo putentcd_l~!"lv~~ - v --acres; uuputeutled_ <br />pant. llo you own or leans these claimsl___ L`---° ~ _ ~~- ~ '/ <br />----- It )J lease, them give Howe of company or person f7um whom brus~:d •- <br />~~ ~-x ---_..__. <br />y o-.-~:-e,~__.- - - (Over) <br />v <br />acres. <br />,I <br />I <br />{ ~{ <br />