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leasing eem- MINE REPORT ~~ <br />.rose Note-Please fill out this report carefully, write plainly and answer all questions fully. Be sure to <br />______.. .. date the report and sign it. Fill out both sides of the sheet. <br />----- ~-----~ Colorado, -- - -----------, 19--- <br />BURI::\U OF DIINES, STATE OF COLORADO. <br />------------- T. R. Henahen, Commissioner of Mines, <br />--- Denver, Colorado. <br />-'~ 1~~~t Sir: In accordance with Section 4?99, Revised Stnt rtes, olorndo, 1908, I submit report as follows: <br />I/ a Compm), <br />en out t 1. <br />.p.ce- othet-W <br />lone it hLnk <br />II . Etm <br />cr pvtnmhtp, <br />ell ~~t tnl. <br />eP.ce: otnml.a <br />Inge It hl.ok <br />pills of Purtnership____.____h <br />Partners' Vamcs P. O. Address <br />------------ <br />---- -------- ---------------------------- <br />C21,±-- ~ --~----------------------~------------- <br />------- <br />r------ <br />~(~f __ Shares, at $__________-._ per share. <br />P. 0. Addressee <br />____ <br />1lfanager -- --- Q ----------------------------- <br />Name of Company-The_____~ <br />Incorporated in the State of__ <br />Principal office __- )f~~G~?'!'-" <br />Capital stock __~~LCZ__! a.% <br />~a <br />President !~ __~-/~~ <br />Secretary .~/~=~-/- ~~ <br />Trensurer~f__~~`-"~1!~ <br />HTnnagcr------------------------------------ <br />------------ T mss of O~vncre <br />_ -- <br />-- -------- <br />~~~~-~-- <br />/~ --------------- <br />.1.!LE_~-r_- -------------------------- <br />------------------------------------------ <br />tip``------ If neLLhnr <br />compm) nor <br />portnernnly~ ------------------------------------- <br />V:______ <br />---- cu oul Ihl. ------- <br />•pae <br />._~_____ <br />--/~ --- <br />lrkmen in the <br />~~------ <br />~@omgaalr`~ <br />P. 0. Addresses <br />nn// ~~ r ------- <br />_1d-~`-'-~-~'~--- ------ <br />_ __ <br />__________ T-~- - <br />~~~~c.y mac_ __________________________ <br />~t;uc names of clalma: .~~~L ~/ v /r//A] Unpntented <br />Patented <br />- ---------------------------- <br />-------------------------------- <br />'total acreage patented-------------------------acres; fnP tented_-------------------- --acres <br />Do you own or lease theso claimsf_~~`-'`="-`--'-- <br />------------------ <br />If yuu lease them give name of company or Person from whom leased-------------- . <br />---------- <br />------- <br />(Over) <br />