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~- \ i ~.. <br />p.~~! <br />~" r I <br />MINE REPORT <br />Note-Please fill out this report carefully, write plainly and answer all questions folly. Be am•e to <br />date the report and sign it. Fill out both sides of the sheet. <br />1 <br />*lJ~-~~ ----------~~.1/-1c?/Ti~-----. Colorado, -------- -~r----------~ 19~/ <br />BL'RTAU OF i11IN1;S, STATIr OF COLORADO. <br />T. R. Hennhen, Commissioner of \tinea, <br />Denser, Colorado. <br />Sir: In accordance with Seetion 4299, ResisedStatutes, Colorado, ]908, I submit report ne follows: <br />Name of Compsay-The---------------------------------------------------------- <br />Incorpornted in the Stntc of_____________..-_..__. _------------------------------- <br />Prineipal otHce -------------------------- - ---- ---- --------------------------~ <br />Cnpitnl stock ----------------------- ."_ Shares, at $___________- Per shore. <br />Ir ~ c°mr.nr' A`ame P. O. Addresses <br />nu ~m t,l. <br />.i~.ce: otheMla' <br />L.vr 11 Ll~nk <br />President --- -- ----------------- - ------ ------------------ - ~- --- <br />Secretary------ --------- ----------...__-----~--~--- <br />Treasurer ----- -- ----- ------------- - ------- ------ <br />------------------------- <br />- ----- <br />Afanager --- _ -- ------------- - <br />Title of Pnrtnership__------_------ -------- - --------------- _ _ _.._-- <br />---- <br />Pnrtncrv' Xnws 1'. O. Address <br />IltOrm <br />nr pvrtn•r.kip. ... _. ._. _. _. _._.. _... ------- <br />nllomtlJ. -____ .__.-.....-.._.. _.._______________ <br />,pun: o~benrirt <br />L.,r It Wmk __._.__ __________ _____________ <br />I_--.. __- ~___.. _ - --._._ .._ -. ____ _ .. _..... <br />llinnngcr_ _" _ _. _ <br />V4~.~i:(/l~Sl/y-cu wner~L~:l~L~l ~ ., _ - <br />-- ~~ - <br />~~ w~ul~rr -__---------------------- ~ - - <br />.ompniy nor ._ .- - -. - - ~ - "" - - <br />_ _. <br />-- --- <br />..,,li q.li pp. I ------ -- -- - _. . <br />r i ant tLl. - .. ---- - <br />I,_hlunugcr.._ - _ <br /><I,11~• n+unes of claims: <br />Pate ~d Illplutrnted <br />~' / <br />/ --- - <br />-- <br />---- -- ------- - ---- jJy X iJ a-a~N _ <br />:IL'1'1'F <br />ueres; uupnt utcd_ - <br />I ~ L11 aorrnge patented ~-`<`-'"`~ <br />- <br />llo you own or lease these cluimst___ _ rLC_..-- ----~ - "_-_-- - - - _ <br />if you Ieas hem give nnmc of com or person tool tvboul Irnsed__ <br />, <br />i .~ <br />Ilii <br />,i <br />~I <br /> <br />i <br />i <br />~I <br /> <br />