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~~ <br />%.~.,.~ <br />MINE REPORT <br />Note-Please fl11 ont tthis~~t both sides oftt elahe t~d answer all questions fully. Be sere to <br />date the report and sign <br />ra,......t.. <br />- io <br />oFFrceus <br />c;; : In accordance t :.h Section 4299, Re~-ised 5tatutz5, Colorado, 1908, I submit :..lwrt na follows: <br />nn ~ .., . ~. <br />flame of Company-The__,5-- -~` ~~z/'C~'~-'1`'_~`--:/VL'v__~!L'~---------- <br />~Incorporated in the S~t{a`te--,~,,o•f__~.ii___~`c'i~'..~~-----((,1---------- ~--------------- <br />IPrincipal office _ ~_~^N."` ~-`~'~'ti~--r~~!'t:.`•a.>~--------------------.. <br />--- - <br />' __ Shares, at $__1~.°__._- Per share. <br />Capital stock t_~D~R~~--------- - <br />c ~ co:nnnn~• ~ A'ame _ P. 0. addresses <br />ell out •hir <br />vp.R: otLerwik C~i ^-~-~ <br />Irestdent ~==_Y1ti__ - ~wiLL~`+--------- --~G~Z..tit•~`_i~c.u.~-4--,i.'.N ~-`` <br />.. SYt-~-~ ~1-- <br />Cecretary <br />y t -; <br />/J---- . <br />;Treasurer _ _•t' t'`~!i :thS ---- ----- ------~k---------%~"p' <br />---~-- <br />'3fanager bC~^'-",~'`-1=~- - 1!i=ti_~.1.--~----- __ _.------ --t/t ------------ <br />~~~ 1 ~ ~ _____ <br />rTitle of Partnerohi <br />p-------------- - <br />Partn~•rs' lamex P. O. Address <br />-'-- <br />- . --- <br />---- - <br />---- ~--k-'------------- <br />------------------ <br />v . c.,n _ <br />er DVrurnhlD. _'______________-_-_ .__..__._- <br />r;lunfthl. ~____ -___-~~ -. .._____. _-_-.__.__ - <br />gm.~mL.r~pr "I _.. __ -_____________ <br />nn~rtblock - _____.-_.- ____________ ______ <br />9fanager- --- ----- ----- <br />laTnea of Owners I'. 0. Addresazs <br />r <br />- .. _ __ <br />~ _ <br />-- -_ _ _ _ <br />----------- <br />r n.nb~~. ------------ <br />nnt _ _ _ _ --- - _ ... <br />~ mlu ~ _ - - --_- .'--- - ----- .. _ _--. .. __.- -. . <br />i <br />-. - -_- <br />~ __.__ <br />Alanager_. ... -_. - - ... - <br />~,.L~~~ uamcs of claims: <br />1!nput~•nten <br />Patented <br />-- - - - - <br />-- <br />rJ Y - LLCretl. <br />~~' ~ `!' -~t - ~-t-------------------- l /~~ <br />'1',nhl ;t~•r~•age pateuted__ ~-+~~----------acres; unpatented- <br />-_ - <br />-- <br />1)o yuu own or lease these clnimst__. _-- - <br />!f p~,o lease them give name of comPuny or person frow wLom leaned_ <br />- _ <br />-- --- (Over) <br />,~ <br />;~ <br />~~ <br />,', i <br />1 <br />~, <br />1 I) <br />1 <br />I: <br />I . <br />1 ~ ( ~ <br />it <br />i <br />~, I 1 <br />.I <br />i <br />i. <br />I <br />i i I <br />1, ~ ~ <br />11 <br />1. <br />