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em- <br /> <br /> <br /> <br />MINE REPORT 114 <br />Nate-Please fill oat tlvs report carefully, writs plainly and answer all questions fully. Be sere to <br />date the report and sign it. Fill oat both sides of the sheet. <br />-------------- ~~Colorado ~q~ti 30" <br />BUREAU OF \IINLS, STATT/ OF COLORADO. <br />T. R. Hennhen, Commissioner of Dlines, <br />Denver, Colorado. <br />Sir: In accordance with Section 4299, Revised Statutes, Colorado, 1008, I submit report as follows: <br />Atame of Company-The---- <br />Incorporated in the State of______________________ <br />-------------------------------- <br />Principnl o0ice __________ <br />u .campaor, Capital stock ----------------------- - _ Shares, at ¢--------__-- <br />DII sot thl. Per share. <br />rParo• oWerww I Nnme <br />Ir.rr it bl.nk P. 0. Addresses <br />u .arm <br />or DrrtornhlD, <br />ml oat em. <br />rryee• othrrwW <br />Inre it bl.nk <br />If odlher <br />mmPrnr nar <br />partnrnhl <br />IIII out taI. <br />~p.ro <br />President _______________ <br />------------------------ ----------------------------- <br />Secretary ---------------------------------~~- <br />Trenaurer ------------------------------- <br />\fannger --------_--_ ~ <br />Title of Partnership______1(~~~ __ ___ ____ ~_ ~j-f~7iL~fi/~-~_- <br />Partners' Xm u•s P. 0. Addr ss <br />-- - - r <br />- - --~ ---A~(1_-P,~C~ <br />----------- <br />---------- <br />--- - - <br />-- ---- ------ ---- <br />-1- ----- ' ------------- <br />1 <br />Afanngcr ------------------------------------ <br />--------------------------------- <br />Names of Owners P. 0. Addresses <br />____________________________________________ _________________________________ <br />Canngcr----------------------------° ---- --------------------------------- <br />State names of claims: <br />Patented <br />` '~~ -- -J~' ------------------------ <br />~' ~~~~r~e_----------------------- <br />Unpntented <br />---------------------------------------------- ---------------------------------------------- <br />'fotnl nereago pntented____! _1_c_______________acres; unpntented___________________________acrea <br />Do you own or leaso these claimsf______.(~%S~?__~~-------------------------------------- <br />If you lease them give name of company or person from tvllom leased____________________________ <br />' .I. <br />I <br />,i <br />' L <br /> <br />(Over) <br />