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w~ <br /> <br />Pirginia <br />~/ <br />MINE REPORT <br />Note-Please fill out this report carefully, write pta{aiy and answer sII questions fNly. Ba sure to <br />dst~ the report sad sign it:' Flll out both aides of the sheet. <br />Central City _; Colorado, ____ &~Y•_ ~± ' <br />• ----- --------------- - - -------=--~ 19--- <br />BUREAU OF bIINES, STATE OF COLORA~Q: ' <br />T. R. Henahen, Commissioner of I<iinee, <br />Deaver, Colorado. <br />Sir: In accordance with Section 4299, Revieed S lutes, Colorado, 1908. I submit report as fnllntpn <br />.'.. ID:... a.. <br />If a eom <br />en !~t tom' <br />~Dlro• othlnL! <br />Ian! It DIlot <br />'{dalltd-vli'C-m p nnq=Th Q:1 <br />Incorporated inathe State'oP___________e_ ________________________________________ <br />Principal oflice f-11-------------- ----------------------------------------------- <br />Cnpital stock ___________________________ Sllarea, at $------__-___ Per share. <br />Name P. 0. Addressee <br />President --------------------------------------- ----------------------------- <br />Secretnry ------------------------ <br />-------------- ----------------------------- <br />Trenaurer ------------------------------- <br />------- ----------------------------- <br />\innager --------------------------------------- ----------------------------- <br />Title of Pnrtnerehip__ 7i8$e_ MLIIB <br />Clear Crssk <br />s . atm <br />!r Dlttnmhlp, <br />an out t61! <br />tplro; athmrW <br />1<ne It blank <br />If nelthtt <br />romDlnr nor <br />Dlttnmhlpp, <br />EII sot t0b <br />!P!ro <br />----------------------------------------- <br />---------------------------------------------- ----------------------------------------------- <br />--------------------------------------------- ---------------------------------------------- <br />Total acreago patented_________________________acres; unpntented_____________--------------acres. <br />.. . . <br />Da'gb,; own or lease these elaimsl_ ~=t~,•----------------------=---------------------------- <br />If you lease them give name o4 eompnny or person from whom leased-------------------------------- <br />________________~~-_3,._______________________ <br />(OVBT) <br />J. <br />Unpntenten <br />----- ----------- <br />)~^ <br />State names of claims: <br />Patented <br />Lake D S Mineral 3nr 190 <br />Partners' \'nmes P. 0. Address <br />Hal Sayre 815 Logan St., Deaver. Colo. <br />-------------------------------------------- --------------------------------- <br />___ Robert_H._ Sayre ___________________ _ Central _City_t_ Colo,_____ <br />---~dfuliad_PenYol~____________________ ___a-fo-iisl-rays:---------- <br />___Heire_oP_Henry_ 11.__Bnidette____ <br />--------------------------------- <br />~iannger__Robert_H._ 9sy_re____________ __ Central_Cit~,_ Colo.___ <br />Names of Owners P. 0. Addresses <br />-------------------------------------------- --------------------------------- <br />____________________________________________ _________________________________ <br />•r:...~. <br /> <br />