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m- <br />S/~ <br />i ,)c> II <br />-MINE REPOR <br />Note-Plesae fill oat Shia report carefally, write ph-{nly and answer all questions folly. Be sere to <br />date the report and sign it. _ Fill oat both aides of the sheet. 5~ ~ / // <br />' -•- - - --- - ---~-~-,-~-~--y~ Colorado, --~~'rY --°~S?~-----~ 19~T <br />BUREAU OF DfIN STAT r' COLORADO vv <br />T. R. lienahen ommissi r of Dfiaes, <br />Deaver, Colorado. <br />Sir: In accordance with Seetioa 4299, vieedStatutes orado 1908 I submit report ne follo~vs• <br />u . cam~aw. <br />CII out V <br />Spare: Otker~ba <br />Inre It blank <br />u .arm <br />or Innnenblp. <br />CII VUt thb <br />rpace: otlmrwlw <br />Inre Il blank <br />Names of Owners P. 0. Addresses <br />If nrithre <br />mnq,an) oor <br />Innn.r.blpp <br />CII VUL titb <br />rpan <br />'Name of Company-The ____ _ ~~+^~'~•~-' _ r~//~ ~o <br />- --- ---------- ----- <br />~~yy ----------------~ - <br />Incorporated in the State of____L_s~ __________ <br />Principal ofdce _~X~~^~,Lf!!!~N <br />r/-J <br />Capital stock t}__ _______ Shares, nt $_ ~~__~ __ per chore. <br />- l- - <br />~Gj'~'~Name ~ P. 0. AdJdres~e~s <br />President ~ G" - - - ---- ~~----- ---~~~w ------- <br />Secretary - ~ ~---'-` - - - --- -------- --------'~...,~- <br />------------- <br />Treasurer --/~--- ---7~--qq ~~~~--~-~~--~~-r-'--'--------- -~- -_~ =0--------------- <br />/~-- - <br />'Title of Pnrtn(ership-------------------------------------------------------------- <br />Partners' Fumes P. 0. Address <br />anuger--------------------------------~~ ---------- <br />.Dinnager------------------------------- ---- <br />tit+dc uumes of claims: <br />''""7 ~Pa~ented <br />E~~A~~Lu!~-G1~ ----------------- <br />Totali acreage patented~ifZ X!~!~D'_,--,-~,, / <br />Do you own orleaeo these claimsi___(1~'~"-"`' ----------------------------------------------- <br />lf you lease them give name of company or person from whom leaeed-------------------------------- <br />-- - ------------------------------------------------------------------------- <br />(Over) <br />':I; <br />~ ~~ <br />