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r .,. <br /> A ' <br />~-~,~' _ ___ ~a_ <br />Character and valve of ore - ~y_~~ ~x -- ,~ <br />___-.___ ~ ~ ~ -Z °o <br />----- --------~- -Dt3 ~ ~~/ .~-L <br />Name of mill (if'any),character and capacity______------ <br />------------ <br />------------------- <br />---- <br />--- <br />___ <br />_____ <br />J <br />_____- <br />_____________ //qq v /p y e <br />C~ 1K /~ /_O _ . _ _ _ ./J ~O <br />Character of surface improvements -~%/'ia~~ ~~~`~ <br />_q 'J __-____..________________ <br />~X /2__•-- - - - - --- -- --- <br />~~--~''Y'"~~ - - ------------ <br />- - - - ~ •X~ <br />----------------- -- <br />-- ---------------- <br />- - <br />- - <br />Amount and character of under-ground deve opmen ___ ~S~~O~-c.. <br />- --- dh _~~~-~~- - -- <br />n - ~!D~- _- -- ---- - <br />~'-= - ~ ~" <br />i <br />',' <br />i <br />~i ~; <br />~i~ <br /><i ;i <br />-------- -------------------------- <br />Signed----~---- - - ---------------- - ------- <br />~~~~ <br />Eltat3ed'by ~ <br />$EOTIOR <br />plnntand en <br />and when aU <br />with the nn <br />address; the <br />with the nn <br />barmen, ore <br />shall be fun <br />Bacrloi; <br />a metallifer <br />forth, or eitl <br />be liable to <br />each provie <br />shall be de, <br />ice date report. <br />i name of eaoh oIa EMPI <br />In oarolully-MEN <br />out blank an oppealte i <br />BUREAU OF B <br />Sra: <br />Name of ctai <br />Lnaation _ _. <br />dining Die <br />Owner or cc <br />Name of -` <br />Capital stc <br />---~~ <br />Leased to <br />Work in <br />Is proper <br />Commen~ <br />Stopped <br />No. EMPLO <br />-~a' <br />_~La <br />_Mi <br />--_Tit <br />_~ _Tr, <br />_-'_Ot <br />_Tc <br />_-'_LI <br />_`_A <br />Avera <br />...,.,...,vo....o. ~.. o..... <br />