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V V l' Kfif/V l ~J ~ C l /1l 1 <br /> <br />°°m- MINE REPORT ~y :l~~G~ fl <br />9 <br /> ,,iqi <br /> Note-Please 8ll 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 />_ ---•-----------------------------. Colorado, --~~----°-~/ ~ _ 19~a <br /> BUL. <br />---- T. <br />''--- Sir: In accordance with Section 4299,Re <br />viaed S <br />tat <br />ute <br />s,Color <br />ado, 1908, I submit report as follows: <br />~ <br />---- Q <br />- <br />- <br />~ <br />y <br />Name of Company-The___~tz~uti/y,,,~_ i[( s>,e, <br />---------------------- <br /> <br />__ ------ <br />Incorporated in thc <br />te of______`__"~ <br />--- - ---------- ------------- <br /> ~ <br />--- <br />lrmcipal office _-- -EG~t <br /> -- <br />----- - -------- <br />--- <br /> n~~mC~r. Capital stock ------------------------_--Shares, at $ <br />-------___-- Per share. <br /> <br />vft. an ../ z 1. <br />"P°"' O1bQ1~" <br />Irrte It hl.nk Name <br />P. 0. Addresses <br />lift. President --------------------------------------- <br />----------------------------- <br />IifL Secretary --------------------------------------- <br />---------------- <br />------------- <br />lift. Treasurer __________________ <br />-------------------- <br />------------- <br /> <br />lift. ---------------- <br />1lannger --------------------------------------- <br />---------------- <br /> <br />lift. ------------- <br />ift. Title of Partnerahip_______________________________________________ <br />----------- <br /> <br />ift. ---- <br />Partners' tintnrs P. 0. Address <br />ift. ---- -------------------- -------------- - <br />ift. <br /> <br />]fY, u . nrn~ <br />ar r.nnrnhlp, <br />IIII uut Wb --------------------- ----------------"---- <br /> <br />___________________________.____ <br /> <br />qwr, o4mrwlw <br />IrY.. I[ Ghnk _____________ ________ <br />___________ .___________-_ <br />.._ lilfanagcr----------- ~----------------------- <br /> AJmnes of Owners P. 0. Addresses <br /> <br />~- ----- <br />2 ~/- /.~Y~ <br />!mod--~ --!1~1~'r <br />+'r~`~Li <br /> <br />__ <br />- <br />I!nritLrr <br />wmp.nJ nor _ <br />------ - <br />____________________________________._ _ _____. <br />_.._ ____~'""j' _ _ _ _. __.__ <br />~ <br />~~~ <br />- <br />- I~unnenhlly <br />..".11 out Wie I __..__________________________________ _.___ <br />//// <br />__ <br /> V <br />_ <br />_ _____________________- <br /> <br />. i-~ <br />u I,9funager __JLrQ.: ~1J_~R-~ '---- - ~ -4^~-----"".-"'-------~ -- <br />a ` - <br /> ~t;dc n:unes of claims: <br />~j Patented Unpntented <br />'~2~r,.~c y~_rc.~ 7 <br />_. _.------------------------------------ --'---t------------------- ----------- - <br />?ulal acreage patented_-- 2' 2 S_ ,atented--_-- ~- -_ .acres. <br />___________acres• un. <br />Do you ou•n or ]ease these claimsT_.___~w?4,~~.'~--~~--~~--°'~-~"-"~=_=~- ~--------- '-'- <br />Ifyw lease them give name of company or person from whom leased_______.. _.._______ __ _ _______ <br />----------------- ----.------------- <br />(Over) <br />