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~-~ <br />~^ <br />_ A <br />... i `/ <br />\1n~n i ~G / <br />MINE REPORT 1~ ~ <br />Note-Please fill out this report carefully, write platnly aad answer all questions folly. Be Bare to <br />date the report and sign it. Fill oat both aides of the sheet. <br />c <br />--------------- f tai-- ~/------~ Colorado C/ <br />BUREAU OF IfINES, STATE OF COLORADO. <br />T. R. He¢nhe¢, Commissioner of JIi¢es, <br />Denver, Colorado. <br />Sir: In accordance with Section 4299, Revised Statutes, Colorado, 1908, I submit report ns follows: <br />r\Tame of Company-The__~%~t~~~~~ ~_f_~_t~_ ~lvi`t~c-.~ ~ ~Jl~'Eoic~ ~. <br />------- <br />I¢corpornted in the State of_______~"QT~Fa `~ jY~Llafi+^-* ~ <br />! /, <br />Principal office __~ _Z__'t_t ~ ~ _' <br />-------- <br />---- - ---- ---------------------- <br />-----.. <br />u. camp.,,r, Capita] stock _~i_0000~0___.-____Shnres, nt $J_?Q-______ Per share. <br />EII wt thb <br />.Dcn: ptheviw .M', Name / <br />l P. 0. Addresses <br />Ime It bLpk <br />President / „f• J~ i° ~ t ~ J (~ <br />~- -- - --------- /tom f r J .r. ~ C ~: ~,/!. /l. t tS?v <br />i --------- -- ------------ - -`------- <br />Secretary ~ p v. [/ ~ r: I , ., / /.~ /%: e <br />Treasurer fit/ ~~' ~ ~' / <br />____.._____ _________________ J_ dt".T____ <br />~lln¢agcr ~ • ~ ~. ~r F d 1/_ /- art„=/ ! l C <br />------------/ --- t ~ i, ra <br />--------------- <br />of Partnetship______________- <br />------------------ ----------------- <br />----------- <br />Partm~rs' X:uecs Y. 0. Address <br />n . etrn <br />cr pnnn.nhip, <br />EII out thb. <br />.Duo: oihrrfbe <br />Inv It Llank <br />^ <br />i <br />a <br />11 <br />I <br /> <br />Jfanugcr__..__'_____ <br />Names of O~vnera <br />P. O. Addresses <br />u cdm.r <br />n+ml~rnr oppor <br />tllrwut GJ~ <br />Rae <br />diannger-------- --- --------------- <br />Stutr uurnes of claims: <br />Pntcated IJn ntented ~ <br />P)/ , <br />__ ~ /i~ Ubil/__/Yr _~ ~J <C-L __aCQ'!'_h~JiGC/ <br />______________________ C /~ <br />________ ~ c J________ / <br />rr ~_________ 2S/{lrr y~~1t~___. <br />--- L <br />Total ucrenge patented_______________ pntented~~P-__/ ~__ rcFr.C/ ~("°"'~crea. <br />__________acrea; un <br />Do you own or lease these claimat__ ~'_!r!'~___ ~fl `^t`- <br />---- -- <br />!f you Icnee them give namo of company or person from whom leaacd___ ____ ____________ <br />----- ---------------------------------------------------------------------------- <br />(Over) <br />I <br />•N III NI\' I~ <br />(uI'wntln~ <br />r~er. r' I <br />~ ~ 1~1 <br />