MINEBK00334

• County: Teller
• Document: Manager
• Suffix: A

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MINE REPORT j •s~~
Note-Please fill out this report carefully, write plainly and answer all questions fu11y. Be sere to
date the report and sign it. Fill out bo des of the sheet.
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______ _ __________ __, Colorado
8tiR}iAU OF itfINES, STATE OF COLORADO.
T. R. Acaahen, Commissioner of Diines,
Deaver, Colorado.
fiir: In accordance with Section 4299, Revised Statutes, Colorado 1908, I~sut,mit report n wa:
Name of Company-The________ _____________ _ _____ _ ! _
------
Incorporated in thr. S to of______ ________ ! _ _.______ _ _______ __
Principal ot5ce -----------------°-!-~^~f(Lf.--------------------------•
Capital stock _______________________.___Shares, at $____________ Per aharo.
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Preaidcat _______ R-""-
Secretary -------- ------------------- ----- '-~--- ---------- i /
Treasurer ___________________.._
'.tinnager -------------------------------------- -----------------------------
of Partnership_____________________
Partners' Names Y.0. ~ddrese
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Names of Owners
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)tanager------ - -- ------------...--
`1111'• names oP chime:
• 1 Patented
P. O. Addressee
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'foto,l ncruage patented________________ arses; unpatented_______._____-.._______
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~pm7• Uo yua own or lease these claimet___ __ ~ _=~1!>-~~~__ ________________________ ______ _____
________ lPyou lease them give name oP company or penoa from wlwm leaeed___________________ ____________
-------- ---- ------- ------- ------------------- --------------
(Over) !