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~ eo¢~. <br />~en~, <br />a rxi_ _e ilver, <br />o._ <br />se_ n.rd <br />i the <br />(Gold <br />s'VERG?tFEN <br />tsny. <br />MINE REPORT 15$ <br />Note-Please Hll oat thin report carefnlIy, write pla~lnIy and answer all gneationa folly. Be aura to <br />date the report and sign it. Fill oat both aides of the sheet. / <br />~- _-_-- ___, Colorado, .C ___________,191 <br />BUREAU OF MINES, STATE OF COLORAD . <br />T. R. Heanhen, Commissioner of Mines, <br />Denver, Colorado. <br />Sir: Ia accordance with Section 4299, Revised Statutes, Colorado, 1908, I s7ub~mit report as follows: , <br />~Nnme of Company-The ~ _ __ ____ ~~r___~~'~-t:v__ <br />ncorporated in the Stn of_____ ~~_________________ <br />'rincipal office _-- ~~-~-_~-_°_•_~._---------"-°-__-- --_____-- <br />~/ ~~ ~~~ ~, ~ - ~L ~ ;cam <br />lap~tal stock ___ ~~_!~- - _ = Shnrea, nt $____________ per nhnre. <br />Nama P. 0. Addresses <br />'resident _ ___ Q-o __ <br />iecretary ------------- - --- - -~------ --------------- <br />Preasurer -------------------------------------- ----------------------------- <br />ifanager _ <br />'itle of Pnrtnenhip-------------------------------------------------------------- <br />Partners' Nnmes P. 0. Address <br />Sfnnnger___________________ <br />Nnmes of Owners <br />-------------------------------- ----------- <br />------------------------------- ----------- <br />-------------------------------- ----------- <br />M1fanagor-------------------------- --------- <br />P. 0. Addresses <br />--------------------------------- <br />State names of claims: <br />i~~~--- Patented Unpntentea <br />------------------------------ <br />---------------------------------------------- ------------------ <br />Total acreage patented-------------------------acres; unpatented___________ <br />_______acres. <br />Do yon own or lease these claimat----------------------------------------'--'--"--'--"--- <br />If you lease them give name of company or person from whom lensed_________________________ <br />------------------------------------------------------------ <br />(Over) <br />' lr' I <br />lyl <br />~'~ <br />ill <br />~ ~; <br />1 <br />~ti <br />