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MINER PORT <br />Note-Please fill out this report carefully, writo plainly and anaNer all questions folly. Be sure to <br />date the report and sign it. Fill out both aides of the sheet. <br />--'----------------------------. Colorndo,:_~s~_./__~---+191, <br />BUREAU OF 711INES, STATE OF COLORADO. <br />T. R. Ilennhen, Commissioner of 1lfines, <br />Denver, Colorndo. <br />Sir: <br />In accordance with Section 4299, Revised Stntn fe, Color/hnd/oj, 1(9/~~08, I submit report ass follows: <br />C'f __________________________________ <br />(Name of Company-The_____-----~-~`°~--~`t-=' V <br />____________________________________ <br />Incorporated in the State of__________________ <br />If ~ Campear. <br />en wt l61• <br />epees; other~W <br />Irve IL bLok <br />Principal office <br />___ Shares, at $__________-- Per share. <br />Cnpitnl stack ------------------------ <br />Name P. O. Addresses <br />President -----___ --- ----------------------------- <br />---------------------------- <br />Secretary ------ ~ ------ ---------------°------------ <br />Trenaurer -------------------------------------- ----------------------------- <br />~\fanager ---------------------------- <br />---------------------- <br />(Title of Pnrtnerehip--------------------------- <br />I Partners' Names P. 0. Address <br />I! . Erm <br />or wnnenkfv. -_________`________________________________ <br />CII out lnl. <br />rpew: othenrW <br />lease It blenk .,__.-____________________________________ <br />____________________ <br />i <br />__________ <br />_______________________ <br />~~IanllgCr____________________________________ <br />~ Names of Owners <br />I--- t~v~_C/~!~~----------- <br />V --- <br />Ifoelther I_______________________________________.._ <br />mmpeN aor <br />pertnerehl ______________ _______ <br />ell one rn~i l <br />epee. I ~_______________________________________ ____ <br />P. O. Addresses <br />~- -- <br />- - - -- ----- - --- <br />- - ------ - - - -- - <br />------------------------- <br />lfnmmger _ _. -------"~" <br />Stute names of elnims: Unpatentett <br />` ~ Patented <br />------------------------ <br />----------- __acres. <br />----------- <br />- ---------- <br />acres; nnpatente _______-- <br />Total acreage patented_____~ ~ _----- <br />-- ------------------ <br />Do you own or lease these claimst_____--Q-!=~~"~-----------' <br />If you lease them give name of company or person from whom lensed-------------------------------- <br />-------------------------------- <br />---------------------- <br />(Over) <br />i <br />1 <br />1 <br />1 <br />I' <br />i <br />II <br />1 <br />i <br />1 <br /> <br />