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~ ~~ <br />"~'r.+-,- -' -~~ f~~YL72f J_-L ~ ~'' i G ' 'l,~ ~1~ <br />NYINE REPORT I(-~.~:, <br />Note-Please fill out <br />this report carefully, write plainly and answer all questions folly, Be sure to <br />date the report and sign it. Filllout both aides of the sheet. <br />-- ~~"~~~F--~--•--`-----• Colorado ~_ ~_/~ _, 19/_9'. <br />BtiRFAU OF 1fINES, STATE OF COLORADO. ' <br />T. R. Ilenahen, Commissioner of Jlines, <br />Denver, Colorado. <br />Sir: In accordance with Section 4?99, ReviaedStatutes, Colorado, 1908, I submit report as follows: <br /> rName of Company-The________________ __________ <br />---------------- ------------- <br /> <br />Incorporated in the State of____________ --- <br />___________ <br />---------------------------- <br /> <br />Principnl office ------------------------- --- <br />------_--- <br /> <br />Il a Comppavr, Capitol stock _________________________ <br />_ _ _ _ _ _ _ <br />_Shnres, nt $ _____ per shore. <br />ell vut ibin <br />prn: oNerwin NIIC6C <br />P. 0. Addresses <br />ime I[ Llank <br /> President ------------------------------ -------- <br />------------------------- <br /> <br />Secretnry ----------------------------- --- <br /> <br />------------------------- <br /> Treasurer _____________________ <br />-------- <br />--------- ----------------------------- <br /> <br /> (Title of Pnrtnership_____________________ ___________ <br />------------ ---------- <br /> Partnrrs' \nnn's 1'. O. Address <br /> <br />IfaArm <br />..________..________..___ <br />- - --- --------- - <br />_. _.._ <br />or Urrtnrnklp, <br />All uut tAle <br />______.____-__._.___.____________ <br /> <br />gore: UthrrvLa <br />lav It Llank ___..__ _-.___ _-__________..__-_____________. <br />-- <br /> lIIfnnugcr----- --- - ----------- ---- _ -- - -------._ -------- - <br /> ~ Names of Owners P. 0. Addresses <br /> ~ --~- -~-----Tj--------- <br /> <br />e nenh~r I---------------------------... - - - - --._. ------ <br />- <br />r <br />m.,.prnr nor <br />parturnlilpp <br />All UUL W6 <br /> <br /> <br />.. .. - <br /> <br /> <br />... _ .... .. <br />.I .f! <br />/~~ .--._... 1 <br />~IllnllgCr. Rlh.iies__~__W /.~.. _ _ ~.~/Jf~'L _l._~. <br />~Lde L:Ila C9 Of ClII]m9: !!~~ <br />Putented Unpntcn[ec1 <br />Z . / --- --------- <br /><'- ---- <br />---•__1--~~------- -v_r,•-ids.' <br />rt-sy _ _r..~srr_ rr ----------~--'------------------ <br />~l'oLil ucrwgc patented_~i'ivr+-T~ ~ ~ - -arre9; unputented_ fi~~-< ucre9. <br />Do you own or ]ease these claim9l__..__`_7is~-.. -~------------ ---- - ~ -- <br />1[ y„11 ]case them give name of company or pereon Yrom whom Icu9ed__- . _ _ __ _- - <br />(Over) <br />;~ <br />i <br />i <br />a I <br />II. <br />,~ <br />1 <br /> <br />