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~~~~' ~ij~clil6 _ .. 0 ~~ ~ ' 7 / <br />1 <br />y ~ ~CI~ <br />eDm. MINE REPORT <br />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 />-- <br />- - ----------. Colorado,------------------- ----•19--- <br />RGRF.9U OF ALINES, STATE OF COIIORADO. <br />_____ T. R. Henahen, Commissioner of Mines, <br />Denser, Colorado. <br />Sir: In accordance kith Section 4299, ResisedStatutes, Colorado, 1908, I submit report as follows: <br />----- Vnme of Company-The------------------------- - <br />---_- Incorporated in the State of------------------------------- ----'-'"-----"'-""-` <br />----- <br />---. <br />--- ----------------------- <br />I'rincipal office --------------------------------- -- <br />(Capita] stock __--___--- - _Shares, nt 4__________-- Pcr share. <br />----------- <br />If ~ Compaa7. r P. 0. Addresses <br />ml nnl IAI, name <br />~li.nr: nmawiae ~ <br />ah7it. !sort it Llank _._________________________ <br />Presrdent -------------------- ----------- ------ <br />shift. -------------------. _..------ <br />3ecretary .___-_ -' <br />------- <br />shift. ------- ------ <br />-- --------------- <br />'frensurer ------------------------------------ <br />s aft' ------------------ <br />-------- <br />5innegcr ------------------------------- <br />shift. .- <br />;Lift. ----------- <br />------------ <br />Title of Partnership---------------------- - <br />rhift• Partners' \nmas --P. 0. Address <br />shift. --- ------- <br />--. -- <br />----------------------- <br />---- <br />ahlft. -_-- <br />slrift• It ,arm <br />nr lurtn.r.hiv. ~ - - ---- ---------'---- -- <br />- ------ <br />- -- <br />shift, nu ant wl, - -- ------ --------- -- ----- <br />giecr; otl¢rwlae <br />____ I•nrr It Llank -__.._____. _..____ _____________ <br />____ <br />_____. <br />- _ <br />_ .. <br />____ <br />~Alnn.lgcr----------- --- <br />~ Names of Owners '' "' "°~'`"-~- <br />--_ - <br />i ---..._. _ -- --- - <br />~~ -- <br />------ <br />- _------ <br />I <br />- . - .... _ <br />---- _ - <br />---------------------- <br />tl ueltber i <br />~~~mpnn nor I _____________ <br />nn.MJ _..________________. <br />p. __-___ ___ <br />I'll uut Wn ~I ~ ~~ - - <br />.pact _.. _ _ _ _ _ <br />_. __. <br />__.__. __ <br />_- <br />__ <br />I -._ <br />~I lllr Lallll•B Of Cllllm&: <br />llnp+tirnted <br />Patented <br />---- <br />-------- <br />------------- acres <br />__ <br />._..------ - --xeres; uuputente ---- <br />'1'utal +ICreugc patenled___._____-- <br />_.. - <br />___ _. <br />Uo you own or lease these claims4__.__-.. -- - <br />- - - <br />1f you louse them give name of company or llersmi from a'L°'° lease -" - - - <br />-- !Over) <br />~~'i <br />~' ~ <br />,~ <br />.,,I, li <br />'~ ~ 1 <br />•tl <br />I <br />•~~I <br />I~ <br />ji <br />U ' ') +I <br />tl ~' <br />~1 <br />