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.- <br />,0~~ <br />~. <br />~, <br />MINE REPORT <br />Note-Please fill out this report carefully, write plainly and answer all questions folly. Be sere to <br />dat_ the report and sign it. Fill out both sides of the sheet. / <br />[-~,t~-~/TL~--------------. Colorado,/-~!/1T~~ -------~ 10~5~ <br />uL-RI:AU OF DIINES, STATE OF COLORADO. <br />T. R. liennhen, Commissioner of ?Mines, <br />Denver, Colorado. <br />Sir: ~ accordance with Section 4299, Revised Statutes, Colorado, 1908,I submit report as follows: <br />` (Name of Company-The---------------------------------------------------------- <br />' ''%/ (Incorporated in the State of-----------------------------------------------" °" <br />~~ / Princip¢1 office ------------. <br />' ----------------- <br />Capita] stocl- ---------------------------Shares, nt Q____________ Per shore. <br />pp , <br />" ° ~°'" '°'' Name P. 0. Addresses <br />OII out thly <br />,pvcr: otharrrlM <br />In~•It hlmk __ __________ _________________ <br />(President ------------------------------------- <br />----- <br />ISecretary ------- ----- -------------------- - <br />------------------ <br />~Treaeurer ----------------------------- <br />-------------------------------------- <br />,, <br />-~.i ~ ~ ' ~ <br />r <br />i~'~~' yip <br />~, `~'i <br />~,, <br />,I: <br />',f <br />~~~G <br />I! <br />veft ~'~ <br />n (~ <br />~hnl 0~~ <br />~Y <br />new <br />(I~ <br />II <br />III <br />(y.° ~ <br />''~ <br />I ! ', <br />.N <br />! <br />r <br />t /1 <br />~`'iiannger -----------------------------~ ------- v'1- ~---------- ---------- <br />(Title of Partnership_~---------------------- ~' ~-"`~~~~ <br />tnr•r~' `~an~s _ <br />~7 <br />If v Orn W~~ <br />nr [nrtnrnhl9. ___________.._.. ____________ <br />m: not ud° ~ ---- - ' <br />gmo-; otherwlve <br />Lm.lt Llvnk ___.__.__________________ <br />l` ~ P~.~O~- ~A,drdress ,~ <br />~{~•_` /-V ~1!tf' //~~^ ... __(iL_7/r-.-tom l_:/ W <br /> <br />( Nllmea Of Owners <br />P. 0. 9 (1dfCS.=.CS <br />n °.ithrr " - - - - - - <br />!nnlp°u! u°r I _ <br />°:vtn.nhl ___________ . <br />11' om to • ~ - <br />.y,m I <br />_ _.__- <br />._.. __ <br />___ <br />____ <br />Tluna er _ ----- - --' - <br />~ B -- - <br />`!ul~~ names of clime: <br />Unpntentcd <br />Patented ____ <br />---------°----------°-- - . oaten. <br />___acres; unputcntcd_-----~----...._". -. <br />'!brut acreage pnteuted_______------------- - <br />-- ----- <br />------------------- <br />Do you own or lease these claimat_________-- --- ~ --- <br />--- <br />- - <br />!f you lease them give name of company or person Yrow whmn leased___-------- - <br />---------- ------------------- - <br />- - (Over) <br /> <br /> <br />CL <br />II <br />Is <br />Jl <br />1~! <br />