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Name o£ Company-Thel//y//"[/ 'i ~/~L/ /~ ~[~ C~ <br />j --- <br />-'- Iueorporat-id.ln the 'S' to of __~ ~ _ I/ '.- - - ' , <br />:Principal office. ' ~~F~1%~ - `------ ------- -------- --- <br />n w oompanx~ Capital stock __ _ ~.~< ~ s~___ Shares, at $ ~~ ______ per share.' <br />w eer t to Name P. 0, .Addresses <br />aphee; :otharwmc _ <br />leave 1461ank ~ ' ~' `i ,~° <br />Qresiden~~ ,~,~//~ ~LL~~'~t'--- -° ----- -~ -- -~-~C'~`~d_ <br />Treasurer 1C~`_LL/ ' ~ ,~ '---- <br />~ -- --- - /~// - --- -- pp <br />' ~~anager' ~~ ---- - ---- ----- ~~~~A~ ~ JC~41 <br />Title of Partnerahp________________ <br />Partners' Names <br />It . 9rm <br />or PaTuere33p, <br />-9nont th5e ____________.___________________.___ <br />apece;'othe:Wlae <br />leavett.blenk <br />~:.NTATA k'P.r _ ___ ___ ___ <br />Namea of Owners <br />----------'r-.------------ ~----.-- <br />U ueftbu ~.. -.... - -- <br />compeoy uor <br />p.rmenbipp~ <br />Nlout. Ynffi - - - --- --- <br />epee <br />g~' <br />S <br />State names of claims: ` `" <br />' - -- ~// <br />~~~~~ ~ ~ <br />J ~~r-j~-.-~ ~ -- ~'- - <br />- F, 0. Addresses <br />_______a __ ____~ ~-_______~ ~ rj <br />~' ~.,., <br />Unpatented ~_, <br />-~i y -_--- ---- -~`- ----- -----~ <br />~ <~~'(~1..sy~ILr~2a1 . _L!1~12,~i2t::!:~/L,¢ <br />Y- _ _______ __ -.. <br />f ._Qld 'i .iE <br />~ `Total acreage :patented__ __ _~cre~, unpatented _~%~~~ <br />Do you own or lease;theae claimsP_ ~~~ v_______ '___-- --------- <br />If you lease Lhem give name of company ar person from whom leased__ ~~. <br />----- <br />_ _ .- (Over) <br />