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7'l~1i~ ,~{. ~~2e- <br />MINE REPORT ~ ~ ~ `~ d <br />Note-Please fill out this report carefully, write plainly and answer all questions fully. a to <br />date the report and sign it. Fill out bath sides oY the sheet. '/ / <br />--~~_j~1 f~~~Colorndo, ----~~~/__l _~~-----~ isl_3 <br />IIURI;AU OF i1fINlS, STATP ~OF COLORADO. <br />T. R. IIennllen, Commissioner of Diines, <br />Denver, Colorado. <br />.lows: <br />Sir: In necordnnce with Scet 19, Reviecd Statut ~ <br />II r Comppm7, <br />OII out n hned~a <br />,Drre: <br />Iare It 61~nk <br />Vnme of Company-The---°---------- ---- ----' - ..--------------- <br />Incorporated in the State of_______-------------- ~-------------------'---~ '--""- <br />T'rincipal office _______-- -----~------~ <br />------------- <br />_____________._ _ Shares, nt :~_____-____-- Pcr share. <br />Capital etocl: __________ <br />Name P. 0. Addresses <br />PfCeldCnt ----~~~- ---- <br />Secretary -- ---------- ------------- <br />Treasurer ________ --------- <br />------------------ -- <br />-------------- <br />J[nnnger --------------- <br />------------------- <br />Title of Pnrlnershi -------'---°'"- <br />P--------------- ------- --- <br />__-- Partners' \amcs ---P. 0. Addr s <br />----~? i/2 ~ -- <br />------------------ <br />u.Mn <br />cr WrtnrnhiD, _______-_.. __ <br />all out ih4 _____.._____-.____________ <br />.pas; aWrnrbe 1 <br />I.r,r It hlrnt __________________..______________ <br />___ <br />__ ___ _ <br />-__ __..J ___.... _-_ _ _ _. <br />____________ _ <br />--- linnagcr---~r /L 2 ~~ ------- ~-- ------'L-CL~~-C'---- /- --- <br />-L----- f YLtC~1. i <br />~Nnmes of Owners P. 0. Addresses <br />--- r <br />---__ _-- <br />--- --- <br />---------------------- <br />II nelihrr ---_---_---- <br />vniq~~ny nar _.-___________________ <br />_.. <br />pa rt ni•nLlp, '- <br />CllnutWDr ___.-________________________________..___-_ <br />.___ .li ae .________.._ <br />--'-- <br />------- <br />~Atnnngcr ---------------------------- <br />State names of claims: LtllpntenteA <br />Patented <br />----- <br />the. --------------------------- <br />--- ----------- <br />---------------------------------------------- <br />.-t ---- <br />---- ----------------------------- <br />______________ - _ LLCI'C8- <br />_______ <br />lntented__: 1- - - <br />----------------nrresp unI <br />'fol;ll acreage pntented__~--- <br />>an7• llo yuu own or lease these clnimst___--~~ -----""--"---------------------------------__-_---- <br />---- <br />If you tense them give name of company or person from whom leused---------------------- <br />~---- <br />-------- ----------- <br />•---- (O~er) <br />-*n <br />I' <br />~~, '~-' <br />r <br />I <br />I ~I <br />I; <br />li <br />~~ , <br />,, <br />F '~. <br />1'. `~ , <br /><~ <br />i <br />~ i <br />i <br />i <br />tl~~ ~I <br />i <br />I <br />I <br />~~~ j~ <br />I!~' <br />~, <br />i <br />I <br />~; <br />i' <br />,, <br />il~'r <br />~~~~, <br />