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n <br />~~'~:~~ <br />ins eom- MINE REPORT <br />Note-Please fiIl out this report carefully, write phtinly and answer all questions folly. Be sure to ( ~ <br />date t'~e report and sign it. Fill out both sides of the sheet. <br />- _ ~ . <br />~ /} -~ ^~ <br />_ - ~ ~ '~ Colorado, ----=:~:_------`------ -• 19. ~•: <br />~P DIIt..- <br />r,en, Conu.... . , .. , ~ . ~. <br />veneer, Colorado. <br />Eir: In accardance with Section 4299, Revised Statutes, Uolorndo, 1905, I submit repots : ~. follows: <br />r~ <br />Vane of Company-The__~%~L~tr1_.~_ cf. L."_!~i__ /1Sac??~` =:--~_'~-------__-- <br />Incorporated in the Stnte,of_;!_L" a~~f2?~~L_------_--- --------------- <br />i ~ <br />".... <br />Principal office _-" `--= = "'-=" '--- --~ "-`--=-~__~,__~_:~__-__:./. <br />Capital stock ~~~'(Tt __'~~~~ i~ . _ Sharce, nt $__,J~ ~c..c~ per share. <br />u' °om""r' P. O. Addresses <br />eu mn :e.. Name / <br />.. <br />Secretary ~j1~ °'-----:Y-- ---------- -- ~~-- ---- ~ ~----------- <br />-r <br />Treasurer __L'~J___ Sr_--:1_.~i--~--'?-=--------- ~J-S_~1~'Dlr._1_~~ •_~•~1 <br />i ~ , i' _ , ~ <br />- , <br />` / ' <br />rtle of Partnerehip------------------------------------------------------------- <br />Partners' >>unr•s P. 0. Address <br />a.am~ -----~ <br />a V.rn.nLip, ______ ___________.-. <br />EI!um obi. ________ _.._____..__ <br />h•e It blYlt __-____. ______________ <br />~ !games of Owners I'. O. Addresses <br />- -- - --- <br />~~~„ <br />ry.a ~ ___. .._ <br />,Atunnger-- - __. _. -.. - - <br />~~~:~~ n.:mes of claims: <br />linpntrnled <br />Patented <br />.- ______________________ __ ..._.--.._ -.r'-_._~-. Cltl <br />----- r uc <br />-__ ---- <br />~. J-- <br />'1'utLl /~// ...acres: unpatented_. - <br />:~.creage patented__~-V_-~-~-------- <br />----- _ _ - <br />Uoyou own or lease these claimtlt________.- - <br />lI y~,u lease them give name of cotnpuny or person Yrom whom leased -- - <br />--- -- <br />- ----- - <br />-- --- - rover) <br />l <br />. <br />I <br />1 <br />