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i I: <br />-1 t'•- <br />r ~~_~ - _ , <br />Teller `~~ ~ .l 1 <br />MINE REPORT <br />Note-Please 811 out this report carefully, writE plainly and answer all questions fully. Ee sure to <br />date the report and sign it. FYll out both sides of the sheet. <br />--___ <br />---Grip-F,Ire_~rl~c~:------- ---. Colorado;n~_r_-;;-r - <br />.~ _ _ - . 101 <br />BLRF.:1G OF bIINES, STATE OF COLOR.~DO. <br />T. P.. ilenahen, Commissioner of Jiines, <br />Denver, Colorado. <br />Sir: In accordance with Section 4°_'J9, Revised Stntutes, Colorado, 100S, I submit report as follo«•s: <br />' (Name of Company-The;::=~;7._ - :ri8_ --- <br />-------- <br />---------- <br />;Incorporated in the State of______________ <br />i Principal office ----- --- ------------ --- - -- --- - <br />- -- <br />, Capital stock ------------ -- -- Flinms, at <br />Cr Compc., ____-__. ~ <br />:u ws cLi. J . '--- --- - Pe share. <br />,~,; o~,.a, ' \ame P. 0. , i resses <br />:,.. a n:Wt <br />~ President -----------------__---- <br />(Secretary --------------------- -- - - _ - <br />;Treasurer ------------------------- <br />-- - - <br />i - _ - --- <br />')[anager ~ <br />(Title of Partnerehip____-___.. _ <br />Partner.' \arue` ~ 1'. Q.:lddress <br />I ~ <br />- - <br />a. <br />n .. Llak <br />i _ <br />Jfanager - - - - - - -- -- -- <br />' Nnmex of Owners 1'. (3, .Iddressns <br />7,, Rceu <br />...u }~~... -7J7..-~T.r.. -N"v--. ~. }-r... - <br />;m~ <br />~ -o <br />y~?'c^tcr,.7ohncon,Tra`, `or <br />lfunuger _ _ I; .L~%i :~c.. <br />'~~1"" •::~n:r~w of claims: <br />Putented I'upat~•nt~•ri <br />'f'n:a ::~~r~;tg" Pulsated-- --~---------- . ---- ar,r~•x; unputcntcd-'------ <br />,: <br />Do"ou own or lease these claimsf_--~='J-=' = •:-'-.:_b~`:`_---.--- ---_.--- <br />Ily:,~~ 1,ss them give name of company or person Ynnn whom Icuscd_- _ -- <br />_.._ <br />(Over) <br />tllf~'x. <br /> <br />i <br />I <br />~ , ,~I <br />