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_ •~~. <br />1 J .. V~t/ _-_ _. <br />eem• • . MINE REPORT 2s <br />Note-Plesee fill ont Shia report catefnlly, write plainly and answer all gnestiona inliy. Be anre to <br />-' - date the report and sign it. Fill ont both aides of the sheet. <br />--~ <br />-- -- ---------~-_-___, Colorado _, 19_(_ <br />----- -- <br />---__ BUREAU OF MINES, STATE OF COLORADO. <br />_ T. R. IIenahen, Commissioner of llfinea, <br />J Denver, Colorado. <br />Sir: In accordance with Section 4299, Revised Statntea, Colorado, 1908, I submit report ae follows: <br />---- Nnme of Company-The__ <br />- -- - ----------------------------------------- <br />---- Incorporated in the State af________~~ _ <br />Prineipnl ofBae ____ _____________________ `/l3 <br />-- ------------- <br />u scam Capital stook __________ ___ Shares at . _ per share. <br />hitt. an sat t,~ --- <br />Iaain It Dl~iak~ Name ---_- P. O. Addressee <br />hilt. President ---------------------------------- _ <br />----- ---------------------------- <br />hift. Secretary --------------------------------------- <br />----------------------------- <br />hiCt. Treas°rer ---------------------------------- <br />---- ----------------------- <br />------ <br />I ~ Manager <br />--------------------------------------- ----------------------------- <br />hift. <br />hift. 15t1e of Pnrtnershr <br />p------------~-~------- - a.~...a~-e/ <br />- ---------- <br />n t' ~ Partn Names ----- _ P. 0. Address <br />Ii ft. " ~S7'+~l <br />----- --------- <br />---------------- -- ---- <br />lift. I , - - -- - - ----- -- ---- <br />a . atm -- --- ----- - - _ <br />lift. ---------------------- <br />---- ---- <br />- ----- ------- ------ <br />011oattute~WN -----------°--------------------------- <br />tpan• othett. <br />----- --------------------------------- <br />___ Inn It b4ak <br />_________________________________ _________________________________ <br />_. . <br />SlBnagCC__________________________________ <br />Names of Owners <br />- - -- - P.-0. dddresaes <br />-- <br />It ad War ________ <br />._ tomWN em ___________ ______________ <br />___________________ <br />artnmNp <br />Sll oat tn0. ____________________________________________ <br />apaa _________________________________ <br />6lnnager------------------------------------ -- <br />--------------------------------- <br />Stnte names of claims: <br />Patented Unpatented <br />~e <br />--------------------------- <br />---------------------------------------------- <br />--------------------------------------------- ---------------------------------------------- <br />Total acreage patented___________ ____________acrea; unpatented_________ <br />------------------acres <br />Ito yon owe or~wgttheee claimsf_-- _ -- -- ---rY~C-[L ~_~_L~_ _k ------------------- <br />If you lease them give name of company or person from whom leaeed__________ <br />------------------- <br />---------------------------------------------------------------------------------------------- <br />(Over) <br />