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Name of i\iine --- ~_~~___P_~-V!-~---..•.---------------------°-^ ---~~-~~~-~f-~'i. <br />-Date of Original Location ___, ~ ____ __~~_ ~ ------------------ ----^ ------- <br />---- ------ <br />~f <br />Location --------------------------D_---- --------_--"-------- -----°--------------------- <br />Mining District __ ---. --------------------- ---- ------------------------- <br />----------------------------------------- - <br />Covnty of_ ____ ~--~---State of Colorado. <br />Title_---`v-v-~~~ ----------------------con ining-_--~-Acres~ <br />r~ /U <br />Y~Ci '~-cC i~.~fI.OZO~~.... _________ _ <br />vested m----- °--------.._.. .-----------°--°------------------------------ <br />Principal Office Located at------- ~°~-~----------------------------------------------- <br />Branch Office at---------------------------------------------------------------------------- <br />Name and Address 06cers----------~-------------------------------------------------- <br />------- - <br />Altitude at Main <br />Character of Country Rock ____~!~~~_^_ <br />Character of Vein _________________t'_:!~ <br />Character oC Walls or Enclosing Rocks ____ <br />----------------- - -------------------- <br />9 <br />Character of Ore_____ ___________ ~~~- -=~"=`-'-- --- --may--`-~-`= ~°-- <br />--------- - <br />z-'° <br />- <br />Ore Occurrence-__ _- <br />Development, Ventilation, Sanitary Conditi u, Exils ._ __ -~!~:=`-`~-G-'=~ <br />__ ._ _ - - <br />--- --•----------•--- --------------------~-----•--------e 0=~'~ - - --------- -- <br />---------- <br /> <br />lr~;; ` . <br />