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<br />- ~ ~~)i>D , r~ <br />MINE REPORT ~ ~'~' j'r <br />Note-Please 8II oat this report carefully, write Plai>zly and answer all questions fully. Be sere to <br />;e the report and sign it FSII out both sides of the sheet. <br />,a <br />ir: In accordance with Section 4?4b, R,.,e~~ise-d-S:utntes, Cgolorado, 1908, . submn , .. , fouo•ss: <br />r5ame of Company-The----`~"?__-- °-------------------- <br />',Incorporated in the State of____'~__'"""'~ <br />---- ---------- <br />~Yrincipal office -- ~---- <br />-- ----. <br />p o <br />Capital stock __~ _P Q~_Q_----- - ~fleres, at G_~ <br />L'^CamVan`, r -- - ~~------- pCr share. <br />Ec ^~"°'^ ' 'game P. 0..lddresses <br />,,,,.- o:~~ ~ <br />kan L' Llnut • 2 <br />President -- ------ ------- - - - - - -_ ~_'°Z~_!C._~ <br />~cretarp - - --- ------ -~- -- - - - -- ---_---- -f - <br />J <br />Treasurer --- ---~_'~_~------- - -- ~-~~~-(~'~---~ <br />?~'Ianuger ------~----- -- --- ------ ----- - ---~ - - - -- <br />Title of Yartnerahip____-- -. _ -- _.. __------ <br />I Partr.~.rn• .<±I.;;~.• P. 0..lddress -- <br />- - - <br />I'~Lrm. <br />w yunu•reLfy. <br />puo-. u•.e•niw ~ . _ .. <br />.m a eW~k ii <br />I - --- --_..- <br />~falla Xvr . - - - -. _. <br />r !~>rraes vT Owuers I'. 7)..lddreseee <br />rn.eL,., .. -~--------~--.._ - _. <br />q..u I .. _ <br />nlunuger <br />~'",. ..."s of claims: L727 ~A'°"~ <br />~l Patented ~'up:~r~ rated <br />~r~ w~ ~ -~ <br />. --___-________ _______________ 1 <br />'fut.! ;.~.r.,,ux,. Pnteuted_Q-~C~f!~. _ (-~~ u"r"s; unrutrater7_ <br />110 Yvo vwn ur lease there claimsY_. S~/'~`~ ,-~- <br />17 ~~~~~.. L;:ur them give name of company or prersoa t7oru wLvul Ir•uscd <br />0 rer) <br />r <br />i <br />ucres. <br />I II <br />i' <br />i <br />