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.m. <br />Ptse <br />50 .0 <br />Ir.cnmswr. Capita] stock _________ _____________.___ Shares, nt 4____________ Per shore. <br />all out t b <br />rrytx: nwtt.w Nnme <br />Irve It blank P. 0. Addresses I <br />President _____________________ <br />------------------ - --------------------------- <br />Secretnry ____ __ ~ <br />-- ----------------------------- <br />Treaeurer ___ _ i <br />- --------------- r <br />----------------------------- <br />M1[nnager __ __ <br />_~ L _• / -- ---------- <br />Title of Pnrtnnrship~l%~~i'C/~_ ' <br />----- <br />P Y-/ly-~-'`-'''---- <br />n lusts' \ trs P Address~~~n_ /~ 1 <br />-~ ------ L ~ <t~" <br />- - - ~- <br />or Da rtnmhl0. / --- "T-~ <br />nnontml. ----------------------------------------- <br />.pare: at he ae <br />Irnr It Lhnk <br />3[nnngcr------------ ----------------------- <br />y.% ~' <br />MINE REPORT isz <br />Note-Please fill out this report carefully, wrt pte' laialy and answer all questions folly, Be ante to <br />date the report and sign it. Fill out bath aides of the sheet. <br />--•-------------~ Colorado _ ~---~ 19~T ~I <br />. ~1~'-v_-- _ I <br />I3URF.AU OF biIN1;S, STATl; OP COLORADO, <br />T. R. Henahen, Commissioner of Mines, <br />Denver, Colorado. <br />Sir: In nccordnace with Sectioa 4299, RevisedStntutea, orndo, 1908, I submit report ns follows: <br />_.. 1 <br />i <br />Name of Company-The __ <br />--- ---- <br />Incorpornted in the State of________ "~ _, ~~" <br />--------------------------------- <br />Principal o0ice ___________________~-~~ <br />~ Nnmea of O~vnera <br />If nrilhtt ________________________________________.___ <br />romp+nf not <br />lurtnenhlp, <br />ml not wl• --------°-------------------------------- <br />npane <br />P. 0. Addresses <br />--------------------------------- <br />-------------------------------- <br />--------------------------------- <br />Unpatenteu <br />-------------------------------------------- ---------------------------------------------- <br />---------------------------------------------- ---------------------------------------------- <br />'fotnl acreage patented_________________________acres; unpatented___________________________acrea. <br />Do you own or ]ease these clnimat--------------------------------------------------------------- <br />If yon lease them give name of company or person from whom lensed________________________________ <br />(Over) <br />~ \(nnnger _____ <br />Shttc nnmce of claims: <br />r Patented <br />