MINEBK00285

• County: Boulder
• Document: Manager
• Suffix: A

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~t~r Y~"'~'' MINE REPORT
l,'~ V~ Note-Please fill out this report carefully, write plainly and answer all questions folly. Be sere to
date the report and sign it. Fill out both sides of the sheet.
t.l~(! f.0 Z!'r „~ ti ------~~!~-----"----------, Colorado, -------------------------• 19_Lc;
BU:
.ner of :J ~.
L4r -J.
Sir: In accordance with Section 4299, Revised Statutes, Colorado, 1908, I submit report as follows:
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;ompany.
(Name of Company-The----------------------------------------------------------
Incorpornted in the State of______.___________________-________--------------__----
IPrincipal office -------------------------- - --- ----- --------------------------..
(Capita] stock ------------------------_--Shares, at $____________ pcr share.
If . comp.or,
011 out t r ~ Nome P. O. Addresses
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President ------------------- ------------ ------ ------------------------- --
Secretnry ----------------- ---------- --------- ------------- ---------------
ITreasurer -------------------------------------- -----------------------------
i
~:1lnnager ----- ---------------------- - ----
------------tC•--//---------G ------
Title of Partnerahip__ V- _ _ _ za.llLa-L___~e =/_L._c~~~_._______
Partner.' !~auu•s P. O. Address
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~Dlunugcr_~'C<Lr/i%'/o-~~~..:L,~_~< _ _. _._ _. - ---- ..-
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( Ivnlnes or owners
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1'. O. Addresses
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I`lfuuuger _ - - _ _ -
titatc uumcs of eluims:
Patented lJnpulcutrd
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'Ibtal ucrcugt, putculcd_ _ _..ucres• u^luttnt~d_ _.l~ ncros.
Uo you own or lease iLesc clnimei__-oL~$~L~~1--=-.-~ ~+ ~t~- - ------ - - -'
if you leans~e/chew give nuy~mJe of company or person Prom/~wh~m leus• __. _- -__ -_ -- - - _~ ~ I
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(Over)