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,~. <br />i~ <br /> <br />. ti"~'''a'"~ ~~,, G~ <br />~,~/~a,~ ~~ MINE REPORT °~~ (,g . <br />Note-Pleas'tf 811 out this report earelnlly, write plataly and aaswar aII gneatfoae folly. Be enre~ <br />date the report and sign it^. -Fill out both sides of the sheet. <br />' rl fi. <br />""' ---- ----___ Colorado '~"u _ 19_ <br />- > -------=--- ~--~-------- • t- <br />BUREAU OF bIINES, STATE OF COLORADO. <br />T. R. Ilenahen, Commissioner of Iriines, <br />Denver, Colorado. <br />Sir: In accordance with Section 4299, Revised S/tatutes, Colorado, 1908, I anbmit report as follows: <br />Name of Company-The________ ~..[_~_5_ __ ~v <br />- ----- ----------------------- <br />Incorporated is the State of____________________ <br />---------------------------------- <br />Principnl office __________________ <br />------------- <br />Ir.CamWy ~ Capital stock ___________________________ Shares, at $____________ per share. <br />en wet l4 i <br />~v~ro~ Dl~anrkb. Name P. 0. Addresses <br />Ir . ern. <br />or p.nemDlp <br />NI out lb6 <br />Ip.rr~ plber~W <br />Iene It Dbnt <br />a ndlbM <br />mm~.or twr <br />wttnrnhlp <br />all out tub <br />•p+ee <br />Preaideat ___________________ <br />-------------------- ----------------------------- <br />Secretary _______ <br />---------------------------- ----------------------------- <br />Treasurer ________ <br />-------------------------- ----------------------------- <br />blanager <br />--------------------------- ----------------------------- <br />Title of Partnership_________________ <br />-------------------------- <br />------------------- <br />Partncrs' lames P. 0. Address <br />alIIaagCC ______________ <br />_____________________ _________________________________ <br />' Names of Owners P. O. Addressee <br />------ --- ---------- <br />--- -------------------- <br />------ ~ <br />______________________ _____________________________ <br />____________________________________________ _________________________________ <br />___________________________ <br />1Cnnager____ _ ___ <br />State nnmea of claims: <br />Patented <br />Unpatenteli <br />R4~------------------` <br />-------------------------------------- <br />---------- <br />Total acreage patented_________ _____acrea; nnpatented__~ ______________ <br />-"- _______aerea <br />Do yon own or lease these claimat____ r~--:r_ <br />If you lease them give name of company or person from whom leaeed_______ <br />It <br />I <br />I <br />i <br />i <br />~' <br />I•~I I <br />i" <br />;r <br />~rl <br />!~. <br />~r <br />!:, <br />,I I, <br />dlut I <br />i ~'f <br />------------------ <br />(Over) <br />