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<br />G; <br />MINE REPORT ; ,''- = ~ _. <br />Fotx-Please 8Il ont this report carefully, wn pte' lainly and answer all questions folly. Be sere to <br />date the report and sign it. Fill out both sides of the eet. <br />~„ <br />L4~ b~ ~ ~-/ <br />----------- - ------ -- -. Colorado '~_tcl<< ~ G <br />------ <br />-f------ - -, 19/-- <br />BrgEAL OF IvfINES, ST6TE COLOR_~DO. <br />T. I'.. Henahen, Commissioner of Hines, <br />Denrer, Colorado. <br />Sir: In accordance with Section 4299, Ite e taints, Colorado, ].nc, <br />~ `?-' I submit report as follo`es: <br />~'eme of Company-The_____ <br />-- ----~ <br />Incorporated in the State of_ ~ ~•~~"!'~. _ _ <br />- - -- <br />~Principal otbce __.li~~~^---- - -- ------------------------- <br />Capital stock __ ~ _'!~~ I~ ~yt_':!~,' c!.,,r,.s, at " <br />c.c~r. -• `------__-___ per share. <br />E11 ou: au - <br />.~.: c.L~-.1+ ~ ~, a ~/ I'. 0. ,lddresses <br />b.e t Lout / <br />President -`- ---- -----!_L 4' j~(L LL - - <br />- - ------------------- ----- <br />;Secretary -------`-~------------~--------------. . <br />---- -- -- <br />~Treasnrer -------`-~--------------- ---- _ -- <br />llianager I _ _ <br />~~__~/ - - - - . -/ _ . _ _ _ A <br />(T'itle of Partnership------- . _,C L 1 / <br />- ---- -- -- -- ----- <br />Partncr~' \: r• I'. t~ ddrlss <br />r . en, <br />a! Nru»niuy. <br />EI: o¢ a... <br />ANtT : r~IM <br />Kl~• 1'11LLLI:L <br />I' Lq:Ln <br />vniNn~ ~ <br />In~lumintrw <br />EI'. w•. tun <br />Ilnw <br />Manager---_ ----. <br />- ----'` ~s of Owners ~.-- ~- <br />-___ - <br />'-Aianagef _ _ _ _ _. _ _ <br />1:1!r b.L ltl!'L V1 Cltllm9: <br />P. O. Addressva <br />~~~ -j ! f` t~ ~~. „/V <br />[, (~ <br />~ ~11!/a! ~'flt l'1: <br />r <br />_-__-_.- <br />'!bta: scryuge patented-- __l_~- al:rre• unl,xtrnted- <br />llv Yvu v+vn ur lease these claimrf_ -~ / ~! - -- - <br /><~J <br />11 vu lcane LLeut give aartie ay or person frvul H•l:vm lensed- "• <br />(O Ytr) <br />1'- <br />