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<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)
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