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~.o q <br />of the leasing coin. <br />). Address <br />"_""'=~ - X41` <br />_for____hourshift. <br />_for___ _hour shit. <br />_for____hour shift. <br />_For____honrshift. <br />.for____hour shift. <br />for____hmlr shift. <br />for__ _ _hour shift. <br />for___ _hour shift. <br />for___ _hour shift. <br />for____hourshift. <br />for____imurshift. <br />s---------- <br />s---------- <br />8---------- <br />Aorkmen in- the <br />Company. <br />r------------ <br />. _ _ ~~~ ~, <br />MINE REPORT -f <br />Note-Please fill oat this report carefully, write plainly and answer all gneations fully to <br />date the report and sign it. Fill out both aides of the sheet. <br />~ J <br />---•------------------ - - -----~ Colorndo ~- L----•19~ <br />IIURF.AU OP 11tINES, STATE OP COLORA <br />T. R. $enalten, Commissioner of \finee, <br />Denver, Colorndo. <br />Sir: In nt <br />If a Comp.nr, <br />EII out [ b <br />upon; otherwW • <br />leavt It blink <br />If .arm <br />or pannrnblp, <br />all out thla <br />rpaee: othrrwlaa <br />leavr IL blank <br />eordnnee with Section 4299, isedStntutes, Colorado, 1908, I submit report ns follows: <br />'Name of Campnny-The------- -------- --------------------- -~--t---- <br />Incorpornted in the State of___~~_?Y_G-d_G ~________ <br />---------------------- <br />~- <br />Principal omcc ~-~-~------------- ~ -~----- ~----------- --- -~-1- . <br />_ -`~ - - - <br />Cnpitnl stoclr _~ ~_Q_OTQ_cz_o_________Shnres, nt $__f ~ °-.___ per share. <br />Name ,Ap ~- P. 0. Addresses <br />President ` ~ ~+l ~ S - ~ ~ ~ <br />, ~ ll <br />Secretary ---~.P~~s~!- ~-=--~ ----- ---------"-------=~--------^ -. <br />L. ~ _ .-, <br />Treasurer ' <br />------- <br />Slnmmger --- -----------^ ~----- 'A'='`"-'-`-'~^ ~---"-`-x-*"'°-tea <br />Will .C, ~uss~F~~ ' <br />'Title of Partnership----------------------------------------___--- <br />Partners' Names P. 0. Address <br />\ __ <br />--~ <br />-~---- - - <br />----__ <br />~IIIOngCC____________.. _______________________ <br />Names of Owners <br />a neither <br />ompanr nor <br />Vartnenhlp~ <br />IIII out tide <br />vpaca <br />P. 0. Addresses <br />-------------- -- --------------------- ----- <br />----------------- --- --------------------- <br />~[nnnger _------------- ------~ --- ----------------- --- ~-------~ -- <br />Stntc names of claims: <br />Patented , lJnpnLented <br />Z~ . <br />r <br />~° - ,~.tA,..,,,, - <br />---•h-- -- --------------------- - -`~-~------------- <br />'fotul acreage pntented___~-(-`-,-~- ----acres; unpntented__ `__________________- -._acres. <br />Do you own or lease these clnimst_____1N_L---~~sl------------------------------------------' <br />IP ou 1 se them ive name of compnn ez;person from whom lensed______ ._ ------------- <br />y ~ y \` ~`- ----- <br />~ (Over) _- <br />