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i <br />I <br />jj!I <br />LI ~ <br />I ~4 <br />I! yon have given n ]cane to others for all or part of tho property, state the names of the leasing com• <br />panics, partnerships or individuals: <br />Name lilnnager P. O. Address <br />Is property worked continuouslyf_______________________________________________________________ <br />If work has Ueen etopped,stntc when------------------------------------------------------------- <br />Nnme, title and address of person in clmrge of wort: for you__________________________________ <br />---------- <br />---- <br />Stnte the character of orc----------------------------------------------------------------------- <br />State the value of the ore---------------------------------------------------------------- <br />DIEN EBIYLOYED <br />No. Employed A'o. F.mploycd <br />~___:llnchine Drillmen, $______for____hourshift. _____Enginccrs, _ _ _ $______for____hourahift. <br />_____Dlachinc IIelpers, $______Cor____hourahift. _____Pmnpmca, _ _ $______for____hourshift. <br />_____.lIincrs, _ _ _ $______for____hourahift. _____Firemen, _ _ _ $______!or____hourshift. <br />__..__Timbcrmen, _ _ g______tor____bourshift. _____131neksmiths, _ _ $______for____hourshiCt. <br />_____Trammcrs, _ _ _ $______for____liourahift. _____Tenmsters, _ _ _ $______for____hoursl~ift. <br />_____Ore Sorters, _ _ $______for____hourshift. _____Foremen, _ $______for____hourehift. <br />__.._ Topmen, _ _ _ ;s______for____hoursl~ift. _____Supcrintendent, _ $______for____hoursl~ift. <br />_____Lnborers, _ _ _ $______for____hourshift. _____OfBce IIclp, _ _ $______for____hoursliift. <br />_____ASSnyers, _ _ _ $______for____hourahitt. _____Dlillmen, _ _ _ $______for____Imurshift. <br />_____Electricinns, _ _ $______for____hour-shift. ____55'ntchmen, _ _ $______for____hourshift. <br />---------------- _ $----__for____]~oursliift. ________________ _ $______for____hourahift. <br />Average number of men employed this yenr__________________________ _ <br />Ia there n mill 7____________________ <br />---------------- ----------------------------------- <br />----- <br />nme of mill-----------------------------------Loaition of mill--------------_-- <br />-------------- <br />hnractcr of tnil]___________________________________ <br />-------------------------------------------- <br />----------------------------------------------- <br />Capacity of mill---------------------------------R'hen leas mill erected_----------------------_--- <br />Oive list of buildings, tramways and other surface improvements __________________ _ <br />-------------------------------------------------------- <br />--------------------------- _______________________ <br />Cost of surface improvements made in 1~J1___ _ _ _ _ <br />Stntc amount nod character of underground development: $ <br />Total Development Amount Done in 191$sf <br />Sbnfts -------------- <br />---------------ft. <br />Winzes ------------------------ ------------ft.;coat per ft., $---------- <br />----ft. ------------ft.; coat per ft., $---------- <br />Drifts -----------------------------ft. <br />Crosscuts --------------------------ft. ------------ft.;coat per ft., $---------- <br />------______ft.; coat per Pt., $________ <br />$ave you reported to this department all fatal and non-fatal accidents occurring to workmen in the <br />twelve mont~~hl1s~~preced~in+g the date o~his report, ae regnired bq ]aw} _____ --__Y_---_-_----- <br />RemnrkeaJ_'.i~.-e_ Cn12,. .ea_ t __ _ ..i ______ <br />~~-- <br />---------~-r =-~==-"Y <br />-----~=5--- ------- <br />------------ - -to__-LD- -~~1 <br />----- <br />-- ~--- _ """"""~~A <br />-- -- - - ------- <br />'p_____ V <br />--------p --- <br />''`~"= ~'"_ ___---~'I°-°-'~^i~~4.Com say. <br />By-- - -- ~ <br />Title--------------------- <br />