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EnacEed; 6y <br />- - - - <br />- - - ---_ - <br />____- - - <br />____-__ - <br />-- 4 <br />_ - - - ~A ~ <br />Character of surface improvements _ - -_ <br />I' ---- ----- ------- -- ------ <br />-- --- <br />- -- <br />---- <br />Amount and character of under•gronnd developmen _--/~S ~- ~2 - ~ /~- <br />~ V ---- <br />-- ~o-S_5--~"`~-- -- <br />---~-_ <br />---- - -- ---- <br />-- --- -- <br />~ --- - <br />~I. ----- --- <br />-------------------- <br />- -- --- <br />I~ ' -- - ---- - <br />--- <br />~,_ -- -- <br />---- <br />l, ---- -- --- --- <br />------------- - ------- -------- <br />G ------- <br />--- <br />---- <br />i .-. <br />- -- <br />-- - <br />~i~ -- <br />--------- - --- <br />------------ --- ------ <br />(jl ~ ----------- <br />t --- ---- <br />i~ ------------ --- --- <br />1II --- ---------- -- - -- ---------------------------- ------------------------------ - <br />,~ ' -- <br />_s,l,' __ -------------------- <br />~~I ------ -- -- -- --- ----- ----------------- --- <br />t <br />I - - --- <br />1I~ ---------- - - - --- -------- -------------- ------------------- ----------------- - <br />- -- <br />~: ' -- <br />$~k j~~i ---- <br />I <br />Signed.--- -'-- ~-- ~----- ------" T`--'/- <br />r <br />m wrtxnroou rto. w., euvu <br />8xcxxox <br />plant aaden <br />and when Bt <br />with the. ne <br />ada:sea; tlxe <br />with the' nc <br />barmen, ore <br />ehallbe fur <br />8rccmxnx <br />a metallffex <br />Portly or sit <br />be liable to <br />each provli <br />shall be de <br />NOTL-Fleoee dale report. <br />Olve name of eeoh olaim be <br />F111 out blank oy o opP d ~° <br />BUREAU OF t <br />srs: <br />Name of cla <br />Location _ _, <br />Alining Dig <br />Owner or <br />Name of ~ <br />Capital sM <br /> <br />