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Im- <br />e~(~-~ <br />-%^ <br />R <br />ft. <br />"'- <br />~~l /i <br /> <br /> <br />MINE REPORT ins <br />Note-Please fill oat this report earefnlly, write plataly and aaswer all gneationa folly. Be sore to <br />date the report sad sign it. Fill ant both aides of the sheet. <br />BUREAU OF TUNES, STATE OF COL ADO. <br />T. R. Ilenahen, Commissioner of Bfines, <br />Denver, Colorado. <br />Sir: In accordance with Section 4299, Revised Statutes, Colorado, 1908, I submit report ae follows: <br />Name of Company-The_____~ <br />~-~.~~~,---- ----------------- <br />Incorporated in the State oP________~a ~~_____________ <br />/ ----- --------------- <br />Principal office ____!~~_'Sy_ ~n__~i~-~1CuU_~~~/J <br />Ir. cam Capital stock ___________________________ Sllnrca, at y~_~__________ Per share. <br />all mrt t~ N""", P. O. Addresses <br />Iris a It bhp nmk ~ <br />President _~ d <br />- - --------- -- -- <br />Secretary r I . , ~ <br />- ---------------I -------,--~-- <br />Trenaurer . r , <br />:tlnangcr r , , <br />If ~ Arm <br />or wnnmhlp, <br />OII sot tbb <br />rpraro; otbervlr~ <br />lrn< It blank <br />Ir n<Itber <br />rompaor nor <br />prrtnrnElpp, <br />C11 out ibla <br />apan< <br />Title of Pnrtnorehip-------------------------------------------------------------- <br />Partncrs' Nnmps P. 0. Address <br />-------------------------------------------- --------------------------------- <br />____________________________________________ _________________________________ <br />pfnnnger ------------------------------------ --------------------------------- <br />Names of Owners <br />-------------------------------------------- <br />-------------------------------------------- <br />____________________________________________ <br />____________________________________________ <br />innnger------------------------------° ---- <br />State names of claims: <br />Patented <br />L/~ du <br />q `~ <br />.i <br />~- <br />Gfi_=Ft~a.------------- ----- <br />~A~-r o.'~ ~~ _ <br />_________________________ <br />P. 0. Addresses <br />--------------------------------- <br />--------------------------------- <br />--------------------------------- <br />_________________________________ <br />_________________________________ <br />--------------------------------- <br />~ ~ _ Unpatentea <br />-- ~/JJ~ ----------------- <br />~"„ ~=--------r------------------------- <br />., . <br />~~~ <br />:res; unpatented___________________________acres. <br />~o yon own or loose these cluimsT____- ----------------------------------------------- <br />you lease them give name of company or person from whom leased________________________________ <br />---------------------------------------------------------------------------------------------- <br />1` <br />If! <br />1' <br />(Over) <br />