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<br />Teller ~` -
<br />..rir,-1~. „reek .,'
<br />MINE REPORT I =~
<br />Note-Please ffiI out this report carefully, cvtYte plaial~ and ansa~et a:l question; fullp. E~ sere to
<br />dote the report and sign it. Fill out both sides of the shaet.
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<br />_ ~ra~o, --:ortr.._cr-1_- , 191.1
<br />BCRE~L OF i11INES, STATE OF COLOP,ADO.
<br />T. F,. Henahen, Commissioner of Dlines,
<br />Paver, Colorado.
<br />fir: 1n accordance with Section 4°_93, Revised Statute:. C'eloru3u. 790c, I s;ILmit report as fo!:ox•s:
<br />~~ame of Company-The_ ri~i_:..lc~i_-;;ol:. ~j.~ v„~.
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<br />- -----ry ------} , --- ___
<br />',Incorporated in the State of_~.41S.r,.44=
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<br />~Principal o>£ce yt;S1_iJ:C_._~t_:,i:__?. ~:.Lo1G. rl,. -- __ --- -
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<br />Capital stock _1,$pp LOft____ ~Larc.t, at :,.UO.>-----
<br />~'~ ~'• I ' - - - ter share.
<br />,,.x; a:ne.r.. ~ Name I'. 0.:1dilresses
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<br />President _S;,c13x tC._T0.^.~.£OII ~`p r
<br />(Secretary l..P,hi ~'r.en ..
<br />Treasurer ~t_~:nf`_i =r~~'--- -- - - 11 "
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<br />'`'tianager _ I~.:,~.L~ i ;;: c• r_ _ - - _ - - _ 11 n
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<br />(Title of Partnership-. _-
<br />Partma~>~' :Ce:u;~~:
<br />lfanager__._--_--
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<br />hianuger
<br />Karnes of O+vners
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<br />~'I:I,~ r.;:lu~~s nl' olaims:
<br />Patented ~ °p'll~ 1.:, ~t
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<br />•.~ ,.,. u,-__..SG~1--- .4.177 :.erer; -
<br />.:•i ''iE _n;>~._J.3.C.7iZ4 1.?25 ~ crt:c /
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<br />~~~"~"I "~'~'~IY,e putented_10.~798_ -. - -. .al•res; unpateat,al. -
<br />b0V0°'r++n or lease these claimsl_Awned i:~ '-i-~' ~'''I"r'f - --
<br />ll}nll L:::,,• than give name of cmapuny or llerson frv~rn nh•nn Icused. --• -"
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