MINEBK01145

• County: Boulder
• Document: Manager
• Suffix: A

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INE REPORT
Note-Please fill out this report carefully, write plainly and answer all gneationa folly. Be sure to
date the report and sign it. Fill out both aides of the sheet.
- --- ---- --------- , Colorado, ---~~-------- (--~ 191_/`.
BUREAU OF DIINES, STATE OF COLORADO.
T. R. Ffenallen, Commissioner of Dfinea,
Denver, Colorado.
Sir: In accordance with Section 4299, Revised Stntntes, Colorado, 1908, I submit report na Pollowe:
Name oP Company-The_ ~ ---------------------------------
Incorporated in the State of______________________________________________________
Principal o03ce -------------------------------------- ---------------------------
u • caa,p~r Capital stock ___________________________ Shares, at ;~____________ Per shore.
011 out thi•
~'.: 10 b ant k~ Name P. 0. Addressee
President --------------------------------------- -----------------------------
Secretnry ---------------------------------
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Treneurer ___________________
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Afanager --------------------------------------- -----------------------------
Title of PartnerahiP--------------------------------------------------------------
Partners' \'nmes - ---P.-O. Address
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State aamea of
Patented
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Unpntented
------------------------n---p---~------- -q--~----- --------------- -------------------------------
Total noreege patented_!~?!`+~' ____E_~a.11_____acrea atented___________________________acree.
Do you own or lease these claimst____________________ _________________
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If you lease them give name of company or person from whom eased r ____~C'4=_ ~rt!?!'_'!-+'h,~
'r~ ca y$ Owners
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