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7Y ~ <br />~~~ ~1' <br />1 ~ `tom <br />MINE REPORT <br />Note-Please fill out this report carefully, wtdte plainly aad mower all questions fully. Be sere to <br />date the report and sign it. Fill out both sides of the sheet. <br />---------------------------------~ Colorado <br />-------------------------, 19--- <br />BliRF.AU OF i<>II.1ES, STATE OF COLORADO. <br />T. R. Iienahen, Commissioner of ilfinea, <br />Denser, Colorado. <br />Sir: In accordance with Section 4299, Re~vi~sed Statutes, Colorado, 1908, I submit report se follows: <br />Name of Company-The__ ~~.'~" ~ ~,1~~ l/l~1/Gl~~+ <br />Incorporated in the State of____~~._ <br />- ----------------------------------- <br />------ <br />Principal aESce --__ ~U------------------------__-• <br />c•rAm~r, Capital atock ____~~~2_________________Sllares, at $____________ per share. <br />°"t t `' Name <br />'~•rc~ °"°'~ P. 0. Addresses <br />lo.r It G4ck <br />President __ ~--------------------------------- <br />----------------------------- <br />Secretary ___-~ j~_ <br />J ----------------------------- ----------------------------- <br />Treasurer ---- f{ f) --------- ------------ <br />`'.1laaeger ------ -T~~~u`a`-~~ - /C e~ `e-'. <br />nn^^ --L~----------- ----------------------------- <br />(lritle of Partnership--y `-~----------------------------------------------------- <br />Partm•rs' '~nmr's P. O. Address <br />---- -Ia-~---------------------------- - <br />-- --------------------------------- <br />u . ~~ <br />or y,nnm6fy, <br />!11 uut tL6 <br />rYac ot6mA•e <br />In.. it LI•vk <br />1..I,rc <br />C:1 wt wl• <br />9u~ <br />-------------------------------------------- <br />lfanager----- ------------------- <br />/f,~~ ~Nnm/e~s of O mere PP. ~0. A~ddre/s~se~ <br />_____________ <br />,9fanager_.~ ~j,~~[~~~L~~tr <br />~'+~~" oalaes of claims: <br />Patented Unpntentca <br />------------------------------------- -~'~i~.~~- ~--------------------- - ----- <br />T'nal acreage patented-----------------------acres; unpatenled__.._.._._--- -- _--. .. acres. <br />1)o You own or lease these claimst /_`Ll.`c[.•_s%i~----- - ~~~/~ ~ <br />_ ~/ ~ <br />if You lease them give name of company or person from whom Ira `ed `</(. -1~[~Q~4-'~L~- <br />(Over) <br />S <br />!~ <br />I~ <br />i <br />~t <br />~ I <br />I <br />;I', <br />