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__ , <br />~~~~ MI, ~ i , ~c r <br />NE REPORT <br />,C~ <br />I, <br />~~ Note-Please fill out this report carefully, write plainly and gnawer all questions fully. Be sere to <br />,I. date the report and sign it. Fill out both aides of the sheet. <br />~ ~~ <br />~'~~s ~ _ (furlXL __~ti~_, Colorado, --~~`-/~ ------__-, 191( <br />BUREAU OF BIINES, STATE OF COLORAU~ ~/ <br />T. R. fienahea, Commiseioaer of Dlinea, <br />Denver, Colorado. <br />Sir: In aceordnnce with Section 4299, Revised Stntntes, Colorado, 1908, I submit report as follows: <br />(Name oP Company-The---------------------------------------------------------- <br />Incorporated in the Stnte oP______________________________________________________ <br />Principal ofllce -------------------------------------•---------------------------- <br />Cnpitnl stock _________________________--_Shares, at :~____________ per share. <br />If • Campanr. <br />011 out t la Nnme P. 0. Addresses <br />spare: aNenrlw <br />lrrte It blank <br />President --------------------------------"------- ----------------------------- <br />Seeretary --------------------------------------- ----------------------------- <br />TreasuD'er -------------------------------------- <br />----------------------------- <br />bfnnager --------------------------------------- --------------------------- <br />If .arm <br />or Dartnenblp, <br />DII out thla <br />apses: othrr~W <br />leer It blank <br />Ir nellhn <br />mnipan) npf <br />parinenhl <br />nll gut tub <br />.pace <br />'Title of Partnership-------------------------------------------------------------- <br />Partnrrs' \rumcs P. 0. Address <br />------------------------------------------ --------------------------------- <br />-------------------------------------------- --------------------------------- <br />Dlnnngcr------------------------------------ --------------------------------- <br />Nnmea of O~vner+ <br />____________________________________________ <br />P. 0. Addresses <br />--~~-/-`L`1(LoY/~L --------- <br />_ lS_.GC t,:~ ~d, <br />titatc names of claims <br />Patented Unpntentcd <br />-- <br />-- -------------------------- ------------- ----~z.cz.,G~y1.~il~~b------------------- <br />--------------------------------------------- ---------------------------------------------- <br />---------------------------------------------- ---------------------------------------------- <br />Totul ncrengo patented__~_ `g ______acres; unpatented___z ~ ___________-._______acrea <br />-- --- {~ <br />Do yon own or lease theeo claimaT______l~C{~L___.ICL_~'------------------------------------- <br />IP you lease them give name oP oompnny or person Prom whom leased______. <br />--------------------------------------------------------------------- <br />(Over) <br />`~ <br />