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pTL-Please <br />- Gire n <br />Fin In <br />V Fill oul <br />-, ;: <br />,'}. <br />~MIN~ REF <br />_r <br />Jar rcpon. <br />ame of meh claim belon¢io¢ m Compvny or croup. <br />nre(ully-NEN EMPLOYED. ~" <br />A. <br />blank on oppoalre aide and sl¢n rcpon, s~''^~' <br />s.~.. <br />BUREAII OF DIINES, STATE~iOF COLORADO. <br />_,.R~ <br />''~ ~ nc <br />V <br />~.. <br />O' .~ . <br />r' , r 'rr""'~^' <br />ram idl j ~' <br />~ .~ <br />a:..~' <br />__, Colo., ____________________, 1f)1___ <br />T. R. IIenahen~ Commissioner of ilIines, <br />Denver, Colorado. <br />Sir: In accordance tvitll the above section, I submit report ns follows: <br />Name of claim or claime______________________________________ <br />-------------------- <br />------------------- ---- <br />---------------------------------------------------------------------------------------------- <br />-----------------------------f -- -------- ------------------------------------------------- <br />Location L%~ / ------ ----- ---- -- ----- <br />-r_-_ -----~ --------------------- <br />~s' ~Ca,~-~r.a-~.c~---- <br />~COUnt---- <br />Dlining District -L - ---------- ----- Y - GCC_C9C=`-"`r=------------------- <br />Owner or ow ra d address------------------ -------------------------------____-- <br />Name of Company------------------------------------------------ <br />------------------------------ <br />(I[ incorporated) <br />Capital Stoc]c-------------------------------------------- shores. ut ~;--_-----_----_----Per share. <br />(P. O. Address) <br />--------------------------------------President <br />°------------------------------------Secretary,----------------------"----------------------- <br />„ <br />--------------------------------------Itlnnagcr, ----------------- <br />------------------------------ <br />--------------------------------------Superintendent -----------------" - <br />---------------------- <br />I,crlsed to ----------------- ------------------------------------"----------------------- <br />11'orlt in ehnrgo oP----------------------------------------------------------------------------- <br />---------------------------------------------------------------------------------------------- <br />Is property worked continuouslyl--------------------------------------------------------------- <br />Cmnmenced worlc -----------------------------------------------------------------------, It)I--- <br />Stopped work --------------------°----------------------------------------------------, 1DI--- <br />bIEN EDII'I,OY];D. <br />iVo. Prnploycd, No. Pmploycd. <br />_____blacllino Drillmon, ~t______for____Iloursilift. _____(:nginccrx, _ _ _ lk______for____Irourrlritt. <br />_____9laclrlna IIellrerr, ry_-____for____Itouralrit't. _____Putnlnnen, _ _ _ _ ly______for____Irourellift. <br />_____111incrr, _ _ _ _ _ $______Por____Irourellift. I~'irenlen, _ _ _ _ ~______for____Irourelrift. <br />---_.fimbonnen, _ _ _ lf______for____hourrhift. Illackemithr, _ _ _ >$______for____hourrhift. <br />-___:l'rurnmcrr, _ _ _ _ ~______for____Irourellift. _____Toutnrtarr, _ _ 4r______for____Itaurrlr3ft. <br />-____Orc Sorterr, _ _ _ $______for____Ilourelrift. _____I+orotnon, _ _ _ _ $c______tor____Ilourrhfft. <br />'1'opmen, _ _ _ _ Br______for____hourrhift. _____fiulwrintendent, _ gl______for.___bourrhtft. <br />----- <br />OO ~~jj <br />__Lnbororr, _ _ _ _ ~_ :for_•1_hourrbUt, _____Olllcu holy, _ _ _ ~______for____Dourrhlft. <br />---__Arrryerr, _ _ _ _ gl______Jor____hourrhtft. _____Alillmen, _ _ _ _ _ 6------for____hourrhlft. <br />------_----°---_---- $______foa ___hourrbUt. ---------------^---- 1-----_for__._bourrhlft. <br />Avcru((e number of man employed for lha year lUl___, ----------------------------------=-------°' <br />Character and value of ora------------------°-^°°-----------------°°---°--____°-°------ <br />(Over.) <br />1, <br />i <br />i <br />I ~ <br />i <br />i 1 <br />F <br />i i~ <br />I, i <br />'I <br />~. I <br />II I ;; <br />I~ <br />