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h,~~+..1~ ~r ~~ ~, <br />ng C0ID- MINE REPORT <br />Note-Please fill oat this report carefully, write plainly and answer all questions folly. Ee sure to <br />date the report and siga it. FIII oat both sides of the sheet. <br />-. '. <br />- f _`r`~---------------, Colorado, lti... (-, ~ . <br />t------------, 19~-- <br />BliRE:tU OF 11fINES, STATE OF COLORADO. <br />------- T. R. Henahen, Commissioner of 3fines, <br />___~ Denser, Colorado. <br />~~L Sir: In accordance with Section 4299, Revi~edStatntes, Colorado, 1908, I submit report as follows: <br />~c.~ rName of Company-The---------------------------------------------------------- <br />--- Incorporated in the State of_____________________________-------------------___--- <br />------- Principal office --------------------------------------~--------------------------.. <br />Capital stock ___________________________Shares, at $____________ Per share. <br />eu wt tLb Name P. O. Addresses <br />or shift. 1~a n~ <br />President -------------------------------------- ----------------------------- <br />ur shift. <br />urshift. Secretary --------------------------------------- <br />----------------------------- <br />nrshift. ~Treasnrer -------------------------------- <br />------ ----------------------------- <br />urshift. ~?~Sanager --------------------------------------- <br />- ----------------------------- <br />urshift. ~~. <br />/ _ r. ~.. .. ,. <br />rtle of Partnershi ~ ~~' ~ ~ ' <br />nrshift. ~' P__ll~rr.__~_~.•:~----'=------------'--= ---'---='-'------------ <br />nr shift. Partm~rs' Xames P. 0. Address <br />urshift• -----}- -- ------------ -----------------~-------------- <br />V J <br />.; <br />llr ehlft, or ynrtom6lp, / _ ;~ <br />el: n wl. -- ~ ~- ~- - f ---- - <br />1 ~ o~hmrW ~ / / r / ~ / -- _' - - --'- <br />' / LL / ~ '~' ~~ <br />----- I ~. <br />--- <br />- l~fanagcr----- ------------ -- ----- <br />----- ~ Names oP Owners P. 0. Addresses <br />_~ ~~ - ---. _ --- - r: <br />t~fi -.. __ -. _- -- <br />_ _____ . <br />~~ <br />r ~.~r,,., i -- - -->- T - ~ r --- - - -- - - -- - ----- --- <br />•amynp oor I ~ ~ <br />_______ ^I+cr .. - _ <br />Om <br />---~ <br />~- <br />is the <br />C__`_`_'~ / ~f <br />--/ . . <br />.~.~(~ <br />sapaay. <br />c=- <br />i <br />'.-Manager -------- ~~---------- <br />~',al~~ Humes of claims: <br />Patented Unputenlcd <br />---- <br />-- 9 <br />' ~. <br />-------- <br />--- <br />'1'o!a~ acreage patented(,,; r-~.-=-._'- ~+~-^~-acres; unpatented--- - ~ [-__-__. <br />, ~: <br />Lo you own or lease these claimeP___ --------'--" ---"-"----- - ------- <br /><~y.e'---'------ <br />!f you lease them Qjve na a of company or person Yrom wham leeacd__ _ ~. <br />.~ ~ / <br />JJ ./ <br />(Over) <br />i <br />1~ li <br />