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~oIIntyZ~a-~~=~~ Dist t~ <br />°m- MINE REPORT <br />Note-Please fill out this report carefully, write plainly and answer all gneationa fully. Be sure to <br />--- date the report and sign it. Fill out bosh sides of the sheet. <br />-- _ lf"` <br />-- - ------------- ~~-----. Colorado, ---I-r!U-~l) ---~-~-------~ 19 13 <br />___ r BUREAU OF MINES, ATE OF COLORADO. <br />T. R. 13enahen, Commissioner of 1lines, <br />--- Denver, Colorado. <br />- Sir: In accordance with Section 4299, Revised Statutes, Colorado, 1908, I submit report as follows: <br />If ~ °omPW <br />all out tbi~ ' <br />.p.en; othm+Ir <br />leave It bunk <br />Name of Company-The---------------------------------------------------------- <br />Incorporated in the State of-------------- --------------------------------------- <br />Principal office ----------------------------------- -----------------------------.. <br />Capital stock --------------------------- Shnrea, at $____________ per share. <br />Name P. 0. Addresses <br />President --------------------------------------- ----------------------------= <br />Secretary --------------------------------------- ----------------------------- <br />Treasurer -------------------------------------- ----------------------------- <br />Slanager --------- ----------------------------- <br />------------------------------ <br />of Partnership---------------------- --------------------------------------- <br />Partncrs' \nmes P. 0. Address <br />If .arm <br />or D~rtnmhlp, <br />all out thl~ <br />vPree: o[herwl~e <br />len~• It bLnk <br />11Snnugcr----------- ----------------------- ------ _ - ------- - ----------- <br />Names of Owners <br />P. O. Addresses <br />--- JOHId D, MERSEREAU. 448NerthMdlnnAua <br />--- PASADENA, CAL.------- <br />__ If nalthn _____________________________..________ --_. <br />aumP~n, nor <br />--_ n.rtnerahl -_____________ <br />-I_..____.-._______________________________ <br />ail out t <br />qnn <br />~Afnnager_°`" O'. V L~I,L,I~t,~~l.4Mq',----- --- - ~-WW?!~ Qlt ~Gb~~6~.0 <br />Uu U ~~.fJ~ <br />Mute names of claims: <br />Patented IJnpulcnted <br />ills S..u ~'1~e,e.~;~~---=~----- -~%'~->~..~-- 'Osw~ °----c~.ee-?q~~t-^-^"~.__...--- <br />--- wC1.ix~i.-t~sni-------'-~(alc~,eA<__('~.~sq.,a.--- 1~t,oq.~------ -~ly{•tx="'ca.'-=`-~°-v---- <br />--- <br />- , <br />- ---------------- -------- -- - -- --- 1Soo x 1 so <br />--- <br />btnnn6tn.nn.~r. bU.wa{actd,-. --- ----- <br />- -- --- -~- 5 -o------- ------I - <br />--- <br />S~nn,~-yt1.l-'-rue. ~.ta.--- <br />9btal acreage patented_____________9._-~ ~ - --acres; un Intented_____._ _____._-- - acres <br />my llo you own or lease these claimat_______________--------------------------- <br />___ if you lease them giro name of company or person from whom leased---_-. _ .- .-------- --- - ----- - <br />11 <br />I? <br />~~ <br />