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Im. <br />y <br />~_,~r~t , <br />-- r/ <br />F .~-o n. <br />G lie . / <br />~'.--° °' <br />ti <br /> <br />MINE REPORT sus ` <br />Note-Please fill oat this report carefully, writo plainly and answer all nestians folly. Be ame to <br />date the report and sign it. E`ill oat both sides of the sheet. <br />--------- -------------. Colorado, ----- <br />----------- -----------------~ 19--- <br />BURF.AU OF iIIINLS, STAT)J OF COLORADO. <br />T. R. Henahen, Commissioner of biines, <br />Denver, Colorado. <br />Sir: In accordance with Scetion 4299, Revised Stn s,~ o rn 908 submit report as follows: <br />Name of Company-The___________ 1__ <br />Incorporated in the State o <br />Principal otTice ____________ <br />.- <br />u.Com ), Capita] stock ----__---- Shn <br />eu oat t u '~ --- ------ Per s e. <br />.v.r.• olherwl.. A`nme P. 0. AddTC99e <br />kne It blink <br />President <br />--------------------- <br />--- -- - -- <br />- - --------- <br />Sccretnry ___________________- <br />-------- <br />Trensurer __________________ <br />-------- -- - --- <br />--- -- ------- - - - --- <br />------- <br />\Innnger ------------------- <br />-----~ -- --- ---1 -- -------------- --------- <br />u . erm <br />ar p.rtnmblp, <br />1111 out thb <br />ryrrr; otnerwW <br />Isar It blruk <br />'Title of Pnrtnership__________ <br />Pnrtnrrn' \nw s <br />. 0. Address <br />``------ <br />i ______. <br />------ ------- <br />----- ----- <br />------~ <br />___ __ _-_ .._ ___r_ ______ <br />-----` <br /> <br /> lSfnnngcr----------- -------- - ----- <br /> ~ Nnrnes of Owner <br /> <br />If neither ________________________ <br />mmlxn) oar <br />M rtnenblyy, <br />hll out tWL <br />n <br />r ~ ________________________ <br />1 <br />Vr ___________________________ (\ <br /> - <br />V <br /> - ~ <br /> ~ \fanugt:r_---_-- _-- -- '_-- <br />- --- ---\ --- <br /> <br />Stntc names \ <br />of claims: ~ I <br />~, <br /> Patented <br /> <br />P. O. _ dresses <br />------------- - - ------ ----------------------------- <br />------------------------------------- ----- --------------------- - <br />-- ----- ----- ------------------------ <br />Total acreage patented_________________________acres; un atented_ _________ncres. <br />P -- ---------- <br />Do yon own or lease these clnimnl_______________ <br />---------------------- - - <br />IP you lease them give name of company or person Prom whom lensed______ _ <br />---------------------------------------------------------------------------------------------- <br />(Over) <br />t <br /> <br />1 <br />± 1 <br />rt <br />i ' 1 ~, <br />.I I <br />i, I l <br />~i <br />~: <br />II . I <br />`1 <br />r1 <br />