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Q ~ 1 I h' ? <br />I <br />C0m- MINE REPORT ~~~,;', ~I' <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. - ~'j1I`I <br />_-~- -Tom!,-----------. Colorado, /~'!~ ~!~?!?~'rJ~ __, 19t_ '~ I, I 1 <br />F3UREAU OF i1iINES, STATE OF COLORADO. ~ II <br />--'- T. R. lienahen, Commissioner of :Hines, <br />____ Deaver, Colorado. (~ <br />---- Sir: In accordnnce with Section 4299, Revised Statutes, Colorado, 1908, I submit report as follows: i <br />---- ~ ~ ~~-------------- ,11 <br />Name of Company-The___ __ <br />- - --------- ------ <br />Incorporated in the State of_-- ~_~1~~0-`+'-!!~ __~-------.---- ~• t <br />---- <br />Princi al ofSce -- ~~'--1-~- ---~---°-`-j'--- -----~ ---------------------.. <br />~~ <br />Capital stock ---------------------------Shares, at :$____________ per share. <br />If • Com an). I ~ <br />en one I. P. O. Addresses <br />Name <br />thlfL, aPaee: othenrW <br />Ira"e II blank ~ x _ _ ~---- ` <br />President ---- ~~'-- <br />Ih~ft. -----------~-Q,.~,( <br />Ihift. Secretary --- ~`=-~1~--------------------- ----- ~-- ------~ -- Q --- <br />-- <br />4 <br />drift. I Treasurer •• •• --;.----=-------------- ---- <br />~hifL, I \ianager -------------- <br />~bift. <br />shift, Title of Partnership------~-----------------------------------~--------------- ,li <br />drift. Pnttncl:~' Xnmlrs P. O. Address <br />-- ------------------- <br />Ihift• ---- ------------------------------------ <br />Ihift. -- --------------------------------- <br />,;~ <br />------------------------------------------ <br />If . trm <br />ihift. or Dortnm6lD. _ _ _. _ __ _ _ _ <br />Illl out thla _ ____________.________________________________ _______________________ <br />apatr o[benrio I ~~ <br />• Iravr It blank _________________________________ <br />__ <br />~I <br />--. _______________. - _ _.__-_.___________.. ____________ ~I ~'~ <br />it <br />~, r / I Ii <br />_____________ <br />.. ~ , ~~. I _______ __-.--_________.-_______.__ I,,~, <br />____ l~lfammgcr_____________________________ ________ <br />____ A'ames of Owners P. 0. Addressee II~j <br />---- I <br />----- ----------- - i <br />I I, <br />.-- If nrither __________________________________ ___ ___ ___-. _______.._____.._.________ ___ I II~ <br />--- vompmy nos - f <br />partnenhl ~ ____..__.-___________ .,,, <br />f,ll out t~ -----~-------- <br />_ _ _ _ .pace 1 <br />II <br />4/ .-__......-._______________________________-.___ <br />.t tr.~:-:~c __________ __________ _ ~, <br />1 ______ __________ <br />~`llfannger ---- ~ -------------------~ -- <br />~Iac names of claims: i' i~ <br />Patented Un putentetl ' ; <br />the ~~E*:e, JL ~ ,/3A..,4QA `°'T - r--- f`"-~ - ------- -1 ^ r , <br />---- ~~,.,« ; j , <br />---- /1allS[~ ;Lllrtas_E/-s/r7~kteset.,~we~~t'~'/~`-'~---- --------------------------------------------~ I <br />t. iii h <br />A /~jq f.'s~~ ,~ <br />'I'ota] acres c ____a:res; unpaLented_-------------~---- -.acres. 'I, li, <br />g Patented------------------t--- - <br />any. Do you own or lease these claimst_____!l'i-s!='-~ ------------""°-"-----~---------------- -- t' <br />____ if yrou lease them giro name of company or person from whom lcased______-- ---------------------'- r I~IL'~~ . <br />(Over) <br />