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Enacted by ~{ <br />~BILCTIOR JA. <br />plant:endemplo, <br />and when~etoppe <br />with'ahe natnee <br />address, thenea <br />with the aambe <br />barmen, ore asec <br />shall be.fnrnisht <br />Bacizoty 28. <br />a metalliferoae I <br />forth, or either c <br />be liable to: a tin <br />each provision <br />shall be deemed <br />ae dete.roPOrt. <br />name of eeoh oiaim betonBL <br />In oarefdlly--MEN EMPLOYE <br />out blank on oppoeile aide ai <br />BUREAU OF M1NE <br />E. L <br />Stn: In <br />Name of claim E <br />-------------- <br />Location (/_ -'r a <br />Mining District <br />Owner or ownE <br />------------- <br />Name of Comb <br />' Capital stock. <br />Leased to _ _ _ . <br />Work in chat <br />Ie property Y <br />Commenced <br />Stopped worn <br />No. EMPLOYED. <br />_ _ _ _Machint <br />_ _ _ _ Machim <br />_ _ _ _Minere, <br />____Timber: <br />____Tramm <br />_ _ _ _Ore B.s <br />_ _ _ _Topnle <br />____Laboxe <br />_ _ _ _AesayE <br />Average n' <br />