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Mine No. .,p,rsoni11jured, ,,r.c OJ flrL 7 ./ Bup'ts No. ...,~,,-,£, /'/)~ • 1atiOJI, (} PR, ril/.1 Aa~ nt, i d0 ~ • 17//' -ft?01 ::;;;fo✓ ¼::f/~._ • i(io/11 ~ . Min<' ate wh re, ,1 1 ,,,t ;,yur" ,n ' ~ . - ···········-··········· 190 Mine No. 7 / Time J rf? ,~ // • Entry No. , ?-/ Room No. ~ . ~~ Mine. Supt. !:/44 Name of Mine Forman //7_ ;}!_ } .. , t.3~ ~~ , /(J/· -0. ~ :meof e of person ~n1uied, /j • Married or Single ~a.,,r-r~ ,,at family, if any, ~ 11u tong in employ, of Oo., . . .vb ~ 0. ndi ·on,fe or Oircu stances, address of nearest ltUtng Relat,ue, · c ~ s t a n C ) r ~ IUI o11e an d ~,,,o.., (;t;o---c;.i[ Pl//t, 1s he an efficient man, :.t - -::;17· 1 J<temperate, CZ,,,/~ • .I ~ nd in whose charge left, ~ f.A/C/ , :e,d, , ,u~,,, /J///f I,ere a (}I . / v-r---..... Y<f/""::kl. · one of Physician called, if any, ~ i>J ~ r - , - < ,; "0' , Jf, /J::Jr-o une and p, o. Adress of Witnesses. zture and extent of Accident, 1 wse, (Signature) >ate J • • ~zh �1 STATEl'lliN'fS OF wrrNgssES. ,, 0 0 L I I I I I ,L l ,.I I •\ �THE UNION PACIFIC COAL CO. Mine No......................................... REPOR1' OF PERSONAL INJURY. 8up'ts No..................................... Name of Person injured, v(/J ~ ~~ · Occupation, ~ ~ Date ~f Accidyjy, - ~ . /..5 ~ / J / / 1907 Locatton, JI"~ Mine No. / 1 If not injured in Mine, state whe1e, ~ ~ =, , ~ a,,c- Time / / Entry No. ;Jl -~ L . -a. 7??- - - - Room No. ~ ~tffJ..,/4~ • Name of Mine Forman, N.ame of Mine Supt. Age of Person injured, 6 ~ What Family, if any, '.1 . . flow long in employ, of Oo., Name and address. of nearest liuing Relatiue, Was he an efficient man, Where and in whose charge left, Name of Physician called, if any, J {J • ~ ~ " a , Married or Single ~ ~ ~~ Oondition of Life or Oircumstances, Was he temperate, J1 ~ · ~~- Name and P. 0. Adress of Witnesses. Nature and extent of Accident, ~ ~ I * -1:, ~ ~ ~ &~ e & - ~ A::-~ Oause, l :J / 0\ (Signature) Date C-7-15-03--0U. 1 t: er 'n}efd Title, ~---c,....-,,,,..._ . 2 �STA.TEMENTS 0 F WITNESSES. {lt' o/ pl !t'.j .., if~- I ti· 1 Afr Wt.JI g,:::• !,'.f.- 11d ),,. Wt:fi (.'or'i /,:.:. . ~d ~ .,ff~., ~fr_f ;:;o/ (3 Kl _ o} I I ~ , ' r �3 Mine No. ....................................... . Fonn 123. 1'1:IE UKION PACIFIC COAL CO. RBPONT OF PERSONAL INJUNY. Sup'ts No.................................... ~ ~ Ai}~ · Name of Person injured, Occupation, ~ ~~ Date ~f Accij£)1t, / ,,..,~ 790 7 Time 3 t:Z.WJ, Locat,on, f/?u-c/1 ~ A 2 , , / / ~ . Mine No. J Entry No. / ~ Room No. ift:? If not injured in Mine, stKw~ere:f - • f 4 ,~ ~ - t!J. Name of Mine Supt. Name of Mine Forman, ,,-6-<AJ · ~,de • Age of Person injured, 62~. . J t ~ · Married or Single ~ What Family, if any, How long in employ, of Oo., ;2, ~ • Condition of Life or Oircumsta~ces, ~ Name and address of nearest living Relative, ~ /'(C'./~/ ~~ ~ , ~➔d, Was he an efficient man, ;Jf~ _ Was he tem~rg,ta, _ Where and in whose charge left, AAr,n--;..,..,_..,c..---v..__,, C1"1r.. Name of Physician called, if any, g-r;........-z...-~ pe:7 ~a. ~* h.~, ·a . Name and P. 0. Adress of Witnesses. Nature and extent of Accident, /J~ ~ ~ ~_,__,L ;-,,& ,;,{ 1 ~ ~ u t. ~ .d, ~~ ~ ~ ~ ~ ~ L_, ~ ~ (Signature) Date C•7-la·03-· 0U. 7 /2~ /J •~ · Title, ~ ~~ �Form 123. THE UNION PACIFIC COAL CO. Mine No. .............................. .,. ........ RBPON1' OF PERSONAT, INJURY. 8up'ts No.................................. m · If;;~~ Name of Person injured, Occupation, ~ Time ¥ ~ Date of Accident, ! ~ ;le 190 7 Entry No. Location, 9£/-?I# Mine No. / tJ If not injured in Mine, sta~ where, f / <:I J~ &--cff:J~ 4-Y.~ tf.?m. Room No. ~?) J wy~ Name of Mine Forma11,1.Name of Mine Supt. Married or Single A " ~ .3✓ ~µy--.g/ Age of Person injured, What Family, if any, How long in employ, of Co., eZ ~~- . Condition of_lifeJ! Circumstances, • Name and address of nearest /iuing Ref!tiue, ~<7· , Was he an efficient man, ~ /I . 12, Was he tem~'Jerate, Where and in whose charge left, "'1/~ ~ Name of Physician called, if any, _,,,,., /(fftr-- ~~ . ~ ~ ,di~~ l?v. 1 • r ~J Name and P. O. Adress of Witnesses. NatureandextentofAooident, o/ -~ ~ ~ vh,(_, ~~~- Cause, (Signature) Date C-7-1:'>·03- -OIi. 1 ~ - Title, j(/. ~ It' ~~ �Fonn 1!?3. THE UNION PACIFIC COAL CO. Mine No. ....................................... REPOT?T OF PERSONAL INJURY. Sup'ts No..................................... J ~-t ' /2~~- Name of Person injured, Occupation, '?7 Date of Accident, Jev1/(/. CJ lZA- ,,,_ / I 190 7 Time / ..2, e; ~ J ( l"l~) Location, ~ Y1/:f0 Mine No. Entry No. / ,/({}f Room No. ;2-t, If not injured in Mine, state where, Cv-J J:;.fh ;3'fl.~ ~ - 7 k /J~. Y. 4,/~ · Name of Mine Supt. ;(:' Name of Mine Forman, Age of Person injured, ,,Z 7 !;4'v7~ • . Married or Single ?f>Ja , / ~ / What Family, if any, ~~ y o0 How long in employ, of Co., ~ ,,,,,,,,r,,,,,¥,, Condition of Life or,CJrcums~caa!J!n e, . <;$~ ~ Name and address of nearest liuing Relative, tf-d,_,~ ~//£,,/,JJ., t1f. JI m Washeanejficientman, Where and in whose charge left, Name of Physician called, if any, mr-o L~ <Jt'~,e • ~· £. ~ic::.ashe~temp ate,,, · / f i > ~ffeV;:,t~a..,l, ~ ~ V Name and P. 0. Adress of Witnesses. Nature and extent of Accident, (Signature) Date C-'7-IS·OO-·0U. 1 Title, ~ . �STATEMENTS OF WITNESSES. �6 lt'orm 12.1. THE UNION PACIFIC COAL CO. Mine No. ........................................ REPORT OF PERSONAL INJURY. 8up'ts No................................... .. Name of Person injured, ~~ • /~() Occupation, ~ Date of Accide!!-bJ / ~ /_ ~ w-vft ,t£,_v ~ o r#£; v location, If not injured in Mine, statf,;,here, ✓, / ✓, 1 1 790 1 Time / ~ {)dcy;,/f"" a.,7"'/) (nc-or.. ) Mine No. cf Entry No. 3-..,t~"'-'-- Room No. cf' J ~ f'3. ~ @ de • y t8Ack ~LAName of Mine Supt. Name of Mine Forman, Age of Person injured, Married or Single .::bl ~v~ • What Family, if any, How long in employ, of Oo., cZ Oonditio~ of Life or Oiraumstan~es, Name and address of nearest liuing Relatiue, ~"--& ~ c.., ~ f/lt ~ /.,, ,. r,--1 . Was he an efficient man, ~ tZ. / Was he t~fi,;e~·fl_le, ' 1 Where and in whose charge left, 6 / ( / ~ ~ N ~ r - -lt/t ,?d,/t:,_z;/ Name of Physician called, if any, <Zf. / /i '17" ~✓l-f?r--u • • / 1!/. ~ - a 1· Name and P. 0. Adress of Witnesses. {if/= Gause, 0 ~- ~ µ ~ 1 ~ ~t;; ~ ~ -f~~ ✓ ~ ~ ~~ ef ,,p/a::;uk,7/ ~ nv ~ L 'l..A'JJ.,./T 1 Pk ~, L ~ ~ ~dfa r,-c_, ~ L ~ /4 n·vd- ~ 4 ,_,,j~ ? U - - . ~ ~ ~ ~~ k J£ ~ ~ :l d., ~~ i d_,_, ~ ~ H ~LJ~ -~~~d,,;,, ~ ~ ~~ , u rkl ,AZi(i _,,,-7 ~ l!,A/r '71/4' 6l,,v(.,,,(, ,ff pdi!!. 1 ,.tl-- ;;· / 0 7 (Signature) Date 1 �STATEMENTS OF WITNESSES, r ,; ,' I I • , !' ' ,; I• . .·•• • j r-·.,. I'·..• I 1 I, r ,: .I f. �7 Mine No. ........................................ Form 123. THE UNION PACIFIC COAL CO. REPORT OF PERSONAL INJURY. 8up'ts No.................................... Name of Person injured, ~ 2.~,/~ Occupation, f Date of Acci<Jf!Ji, £ ® . o2. -3 ,,_ Location, tJ'~I • u ~ ~ / If not injured m Mme, sta{{~here, Name of Mine Supt. »J~t,..,-V'(_,/ 190 7 g,,c/~ . Mine No. ~ ~1(3_,l/,,c;.,/( .. t~ . Time / <f t:Jo/!,.c/ 1 ,:;Z. n:;. Entry No. S I Room No. Name of Mine Forman, ,,,(/). ~ (}_, • • - :. ~~ Age of Person m1ured, ~ / Married or Single Q/) /) • What Fam,.,y, I;;.; any, U_ .? f f ' ~ How long in employ, of Go. , I/' ~ ✓~ Ojndition of Life or Circums~es, Name and address of nearest liuing Relatiue, ~ ~~£.-?(, (/w-cdf.-. Was he an efficient man, <J:/t,,<V • /;:> Was. he tt1)gera l<:, Where and in whose oharge left, ~Q;~- ~ 0 ~ , . Name of Physician called, if any, "'?/, // Name and P. O. Adress of Witnesses. Nature and extent of Accident, Gause, I (Signature) Date C•7•HHl3··Cll. 1 v- // ez{~ • / ~ -; 7,,,-,A,~~ e -~ �STATEl\1ENTS OF WITNESSES. I. I • lj .,' �Form l!!:l. THE u~roN PACIFIC COAL co. Mine No. ........................................ REPORT OF PBRSONAL INJ URY. 8 8up'ts No.................................... Name of Person injured, d, ~ . Occupation, ~ ~ Oata~JAo~~' ·,_,,//-fa Location, . . -~ ,, ~ If not injured 1n !,fmc, state whe(/e, Name of Mine Supt, Age of Person injured, What Family, if any, h ~ -£./CA...,;'l/ 190 J Time t; ~ , r £. ;;?J. fv'line No. / ~ Entry No. Room No. "--:' 0 -;,,-- ~ • ~ Name of Mine Forman, ftfarriefr);;gle ~i ~. ~ ~~ 1fe, ~ - How long in employ, of Oo. • &> ~ • 'i_ndition ?f Life or Oir°)jf1st(!-11ces, Name and addr:ss of nearest liuing Relatiue, C , ~ / (~v<-~,-v;;) ac/(. Was he an ejjicrent man, ~ . tJ_ Was he tcmpemlt?, ~;J • Where and in whose charge lej(I ~ ~ V ~ v r t l~ ~ •>?P Name o~ Physician called, if any, /i U 'J /; • t~/d - J Name and P. 0. Adress of Witnesses. ~~~~ Nature and extent of Accident, ~ Cause, / ~ ~ - urL--t_, (J/v~ ~ d t~ ~;,v ~ ~ (Signature) Date C-7-15-ro...ou. /~k 1 )· Title, /.)k ~ ~1 �STATEMENTS OF WITNESSES. ... I . .. • - �. THE U NION PACIFIC COAL CO . 9 Mine No........................................ . RTSPOR\'. T OF PERSONAL INJURY. 8up'ts No..................................... / ~ •~ J . / • Na,ne of. Person i11jured, . M , Occupation,. ~ Date of A c e ~ ; { / · 790 7 Time Location, .~ ~ v t - ~ /~, Mine No. ~ Entry No. If not injured i11 Mi11c, state where, '7 ' ,,,,., k {:, r Rd£r. 2-:ru:.,,c ,h~£cA- -¢ h Room No. / -3 ,/{}-_o O. . / ;JA ~ Name of Mine Supt. Name of Mine Forman Age of Person injured, If v~ Marrie~ or Single /i -~~ What Family, if any, ~ How long in employ, of Co.' o/ » J ~ , Condition of life or Oircumstances, Name and address of 11earest living _Relative, J:/ '1 %~ Wa.she an efficient man, Where and in whose aharge left, Name of P/lysioian called, If any, , ~ J3a.-c,ff-/ Was he temperate, "Cift'tVr"~ • ~ /;L> Name and P. O. Adress of Witnesses. Natu~e and extent of Accident, ~ Cause, (Signature) Date C-7-1&-0'J--cu. 1 ~ 1:{ ~ · r/ �STATEMENTS OF WITNESSES. ;.. �1() I THE UNION PACIFIC COAL CO. Mine No. ........................................ REPORT OF PERSONAL INJURY. 8up'ts No.......:........................... . Name of Person injured, Ac,tlA../ r/% ~ Occupation, ii .-cf_ Date ~f A c ~ _Jj:r. ,;V -1-t~ Locat,on, ef,,;lC/4A~ / If not injured in Mine, £/a~~ wlfo/e, ~_,e,r-190 7 · Mine No. Time cf ~ (2. //'/_ Entry No. ~- ,. Room No. ~ NameofMineForman,~~ .. ( ~ NameofMineSupt. ~t!3~ 7 Age of Person tnJured, ~ ~ ~ _,, 1 Married or Single -<fin~ What Fam~ly, if any, %"ti; ,,~ J ~ How Jong tn employ, of fJo., 3 7?,}~. fJon. ·uon _of Life o: o;_:c;imstqnces, Name and address of nearest lturng Relative, ~~ u<i,<.,-vz.,,,v,a(;;; (}wv ~ ~ Was he an efficient man, ~ . /7_ wa: he ten( aratn, / '7d,--/5Au , ,. ,,. Where and in whose charge left, ~.,,,,.,"'7L,<....,,/L.,C,, -✓GJ~ • ✓-' I ~ ,. Name of Physician called, if any, 'lL,l,v--lt./4-1..-<..A'i[,,, V /vf,,,r,l./7X;/f/ v · ,.. ~4 Name and P. 0. Adress of Witnesses. 41~~' rd~ ) Nature and extent of Accident, (Signature) Date C•7-lr>·03· ·OIi. 1 ~~c£ Title, -f.CJ ,..,vy) / I___p,.,rt.,,R- / . ~~. i �STATEMENTS OF WITNESSES. I ' �11 JJ_ Form 123. 'l'IIE UNION P _\C TFIC COAL CO. Mine No. ........................................ RT; J>ONT OF PERS ONAL INJUNY. 8up'ts No................................... Nama of Person inju~ ~_,,,,-</o??'n.<~ /?'J,'l ~ r Y I A / d Occupation, {t;r '.& Mc:~V"'Yv~. t:Z, ~ Date of Acc!J!!!!>t, L / /,,r/_ :tl c ½_~ . 790 7 Time Location, V.j,;-c/f"./ e:f ~ e , , v ~1 Mine No. 7 Entry No. (J. ~ o o m No. If not injured in Mine, state where/ 1 J el/'~ _ v ~~~ Age of Person tnJured, ~ r ~ · Name of Mine Supt. Name of &tine Forman, k ->{:'"~~ · Married or Single ,?J~ What Family, if any, /i How long in employ, of (Jo., ~ / /"" 1:f~ondition of life or Circumstanc~s, If /2) L A/,,,,_ Name and address of nearest ft!t'uin Relatiue, //7JJ-,-o . ~ Y1J~c~-n,,,t..,,C,/e1 l1/4:,/u~ Was he an efficient man, _ fA2./ , ,f., ~she t penic, "PJ ~ Where and in whose charge lef , ~rn,l/4/1;:f_ / ( [ J ~ // <#, - ~ ,,,:;i{ Name of Physician oal/ed, If any, \./Z,'(.,/;,(',/'~.v-c,,,, ~ • Name and P. O. Adress of Witnesses. Nature and extent of Accident, ~ ~- .,., 'I/ fjf •11" Cause, A / t t t1 .,;J • ,:d1 J ,✓, ✓ ;17,1' ,,,t v.· ( ) (Signature) Date 7 k~4Zr 7 ~- Title, st::' �STATEMEN'l'S OF WITNESSES. .l 8ocr: 0 r.· ·- • WYO- r ,;;- - //~/fa/ ul- !,tr"-- ,,<,J-;;;u ~ 0 Nl ~ -~ /tfl ~ /,/ / ~ J-~ ,_/;/J- @d,d (}?'PJJ, >'??~,_ f:(j./J,_ f,dk;r ~~ L ~ ~ :, /4fl, ~ ~~f I !; ~ a,JkL ~ -1:t- .Er- f- : Y~/ ~ ~afe- - ~(¼;,,,u& ~ :n. ~ ~ r I '' 1, .... l I l ' I ' r, . I �12 Mine No......................................... Form 123. 1'HE UNION PACIFIC COAL CO. RZ.:PORT OF PERSONAL INJUNY. 8up'ts No.................................... Name of Person injured, f/J&~ Occupation, tf) ~~ • Date of AccjJJg1t, _-~~ c!f'a/2 ., 190 Location, ~ • _ Mine No. If not injured in Mine, state h re, / 4)4 w% J Time ~'/J - t?.~. Entry No. 3 / t? Room No. / cf fJt! @ ~ Name of Mine Forman, .J.. Name of Mine Supt. Marrie'/t'f::;,e ~~ Age of Person injured, ~ I "'11 ~ What Family, if any, --3/n<--U • -:_( _ L How long in employ, of Oo., / / ~ Oondition of Life or Oircumstances Narne and address of nearest liuing Relatiue, /'//4-o /(/7!3,--;({J~,rn._,' Was he an efficient man, t1_ Was he temperate, ve.--- • Where and in whose charge left, ~ /{[/-:;:~ dfr 0 d ~ Name of Physician called, if any, ~ !Y J ef/1,e. Jt~ . Name and P. 0. Adress of Witnesses. \., Nature and extent of Accident, (\ "'\ \J Date C-7-Hi-03- -0JJ. 7 ~J f.::;r "u , =. �STATEMENTS OF WITNESSES. I • I �1~1 Mine No......................................... Form 123. 'l'HE UNION PACIFIC COAL CO. REPORT OF PERSONAL IN[URY. Sup'ts No..................................... C:Z-:tt ~~ Name of Person injured, -:Occupation, 7;7r"t,,,(ADate of Accij,Pt;J!D /f cfo✓ 790 Location, (4,-#--c~ a;p,,,.,.vt'~ f((;!f(J--. . Mine No. 1 If not injured in Mine, state-where, /j <.J $1 f Name of Mine Supt. ~ ~ // -l'fA 7 Time /..2, ·rtJe,,k-cA:; ( ~ ) / Entry No. ,,2, 17,e, atf-Room No. 3 Name of Mine Forman, , b ~ . t f c· Age of Person injured, ;2/0 - ? , f r ~ Married or Single /'?J~~ What Family, if any, .)7cr7t!Jt./ • ,, / How long in employ, of Oo., .Y}?t/7/t/t4tAv - f}-Onflition of)f!ifjJOY_ Oircmances, jl . /J// Name and addr~ss of nearest living Relative, »::JTtJ ~ ~ ~ . , (/(A'-c4"., r t J / A , , v - V ~ / } ( / ~ . Was he an effic1ent man, /2, Was h - te,~ 1p~r., <f(fk/ • Where and in whose charge left, ~-vp~ ,;6/~...-u/vJ {,,/1//i;t' 1 Name of Physician called, if any, ~~ #4'-:;{ ;;:.-~ . 7 f?(t.&· . Name and P. 0. Adress of Witnesses. Nature and extent of Accident, Oause, (Signature) Date C-7-15-0'J··IJH. 7 fl~~/4 Title, -,,rf ~ ~ �F' ,:,:-:;: P' l NG~ Wya;,. ~ - µ ,3 - 0 7 i I I Roe:: . l }{Cs. WYo. 7 Yo - 11 7 �Form 123. THE UNlON PACIFIC COAL CO. Mine No. ........................................ RHP01?1' 01" PBRSONAL INJUNY. Sup'ts No.................... ·····-········ Namo of Person injured, ~ 7/}~ /) ,f- ~ k r . Occupation, Date of AacjJ/jnt, .:VI ;:_;1 Location, f ~ ~7°✓ Y%?J<1. If not injured in Mine, state wRere; 'ed<Ji'-<! 190 7 Mine No. ~~ +~~ ,J__,,..;(9" NameofMine~upt. Name of Mine Forman, ~c.__,,., • Age of Person tnJured, , __.J Marrie'Rr;;::;,e 1 What Family, if any, T~ . How long in employ, of (Jo., 0""" ~ - . (Jondition of Life o.r Circumstan~s, I Name and address of nearest liuing Relattue, ( ~ ) -f!:J~a,-a,,,r'vC I Cf Was he an efficient man, 1j ~ I . CZ, Was heJ,.e~,yn pera ., / / ~ • Where and in whose charge left, A S / ~ £J1'P.i ~ I Name of Physioian called, if any, ~' ~ o-" -~ . 4~ ~~ w~ /Uf:{ Name and P. 0. Adress of Witnesses. Nature and extent of Accident, Cause, ,r I I (Signature) Dato 1 ,,, J/ d W. �ST,\ TEJ\lEN'fS OF WITNESSES. r I•' .': ·,... .. ,I, •\ �11 ~ lu F01'Ill l23. THE UNION P .ACIFIC COAL CO. Mine No. ........................................ REPORT OF PERSONAL INJURY. 8up'ts No..................................... ~ ~/ . Name of Person injured, Occupation, v';' ~ Date of Acc!fi!Yt, f /J// Location, ( ~ -~ ~ , , If/ti~ • If not injured in Mine, state wh{fe, <I #~ / 190 Mine No. ~~~ 7 Time fr ~. ~ ~ --- /c, ;,n Entry No. f1 ~Room No. m .i:f.'~ ,:;?.- Name of Mine Supt. Name of Mine Forman, Age of Person injured, ~✓ J 1 ~ / .,, / Married or Single }7?~ What Family, if any, ~ ?-- . e , ~ How long in employ, of Oo. 7 ~011dition of Life or Circumstanc~r·,1 ( c f ~ ) Name and address of nearest living Relative, .It;~ ~ I[ l{;; ~: ~ r •~1 ~ Was he an efficient man, ¼/ . _ Was he temperate, ;Jt~ V Where and in whose charge left, ~ ~ ,,, JJ /J Name of Physician called, if any, Vh1--t:.A'-"V~ !/ ~~ Jt.,'-(c, I m~ , .,,-,r/lAJ ;::j Name and P. O. Adress of Witnesses. Nature and extent of Accident, Oause, (Signature) Date C-7-li\·03··011. 7 , c.J �. OF WITNESSES. sT.\TEl.\11SNTS RocK S P RI NGS. Wyal /1 &~ .?-t7. / I ~ J II I, l �'rHE UNION PACIFIC COAL CO. REPORT OF PERSONAL INJURY. - ·f r ?> ·! ("ti JL V l,'orm 123. - Mine No. ........................................ 8up'ts No.................................. Namo of Person injured, d ~~~ • ~~ Occupation,. ~ Date of A o ~ t, .,r,,---~ fc:: : ;~ ; : ;/r y //.// Location, I I Y~ If not injured in Mine, state whe , Name of Mine Supt. 190 l Mine No. ~ ~ /c Q ,,t'Je,, T:in1e ::;..... ', 3--1? {J • 'n-?. / v,.., Entry No. SRoom No. Name 0'J,-t: M"me rorman, c- & a,,v1 (},If ){c(j. / / /7)~ ~ Age of Per~on ~njured, d ~ ,,,.o/ ~ • / ,~ / Married or Single • ;,,l.l~ What Family, if any, P1/]' ...,. a,.,,,,,c.4 ?-' {!/4~ How long in employ, of Oo., Condition o~-F /. • 'J L1r""e 1, Or a· ,raumstances, 1 Name and addr~ss of nearest liuing Relative, /{Ir ( , l A , , C A { H , i ~ ~ ~ t A ~ · Was he an effio1ent man, <21 v<2./ --.,, t t , rt'¥ /( tJ ~ • /. ~as. l'! 1111,cra e, (l,,f v Where and in whose charge left, ~ ~ J(/--uLe.,, // Name of Physician called, if any, ~ /J 'll"7 2Jd'a-.,,~ ~f Y I~ · AA Name and P. 0. Adress of Witnesses. Nature and extent_• ! Acoide:r ~ b vr- h1/ ~ LJ e,,,J-Jf" Cause, (Signature) Date C-7-1:'>•CXl-·GII. 1 ~fit/~ Title, -;,t==/~ ~ cfi:.r~ �, STATE1'1ENTS I I I II I I I I OF WITNESSES. �E'onn 123. TUE UNION PACIFIC COAL CO. - --- Mine REPORT OF PERSONAL INJURY. Name of Person injured, ' 17 No. ........................................ Sup'ts No.................................... ~t:?/~J ~hl!-4 £,,,r/7:,d ~ / / oco11pat1011, t;,· / ,:-rt.,,<.,-,rOate of AccidjJJy / ,fc!;j_vr--- Y .v -f/4__ 100 1 Location, ~ ~ , : ~ ,.,, Nftf~ • Mine No. If not injured 111 Mme, state whe,~, Name of !line Supt. _..,,_ ,,,,,,,,,, Age of Person injured, What Family, if any, How long in employ, of Oo. I •• a ;If ~ • ~ Where and in whose charge left, Name of Physician called, if any, Entry No. .3 - ,;{l& Room No. Name of Mine Forman, Married or Single ';!f ~ Name and address •f nearest humg Re/atiue, "' man , ()? eve// r,a s he an e'"eient »' J. 9 -t:C. »7 f 4--tJ. ~ /4_ • ~ -u,,_,,,,,,,,, '3 I Time Condition nf liffJ or Oircum tances, ~ - --/ ~ve..( 1/3/~) £~~ /2V • _~ '1!:.-,.,// ~ /J) r ·~;,;;rv - ~r Was he' temperate, ~.....a/ "'✓";1/°, VU,,,U· • // <21A',_,~ AA '/(- ___ / / v- /l // . ~ 1· Name and P. O. Adress of Witnesses. Nature and extent of Acoident, ...,,,a_,,, ( (Signature) Date C-7-11>·03··1lll. 1 ~~. t2:;/e--· Title, 'Fj' ~ ~• �STATEMENTS OF WITNESSES. -: �1'TN{ON P.\CIF'IC COAL co. 'fll°B ul - . -1' OF PERSONAL INJURY. R!WOR Name•f_Personinjured, / ~ lLc, . Mine No. ....................................... ~;J2-?<., ~ 190 l Mine No. - Time / ,,~ {? ;t7J Entry No. ---- I' ReORFNil. tfJr?~i, ,d,,~ ./~t{}~ <Jf Name of Mine Forman, ~ tiJ ~~- Married or Single 'P??~tAf Age of Person injured, 3~ ~ What family, if any, o2/ How fong in employ, of Oo., / 3 ctf ~ Oopxlition oJ Life or Oircuinstancy_8J fl, Name and address of nearest liuinfelhfiu~, ~--r-0{ f a /- ~· ~1 ~ ,n; • t an /. / Was he an ep,cten m , / .1, . Was h temperate, • Where and in whose charge left, ff~ ) ;J / Name of Physician called, if any, (!J~ o / ~ 7?~~ tt-0: N. Name and P. 0. Adress of Witnesses. (Signature) Date I 8up'ts No......... ........................ f:{/. ~~ occupation, 7. h / oate of Accident, //1 /✓~ 1: 7 Looation, ~ ~ ff not injured in Minr, ate whcrb, Name of Mine Supt• -~ (...) Form 1~. 1 e~. , �STATEMEN'fS OF WITNESSES. �·riIE U.L'i _ - ·j"·9.. Form 1l!3. ,110N PACIFIC COAL CO. · ,r OF PERSONAL INJURY. RISI'01\ I 8up'ts No. ............. ········· Nam• of Person injured, ()£,-c.,/' ~ , , . - 0 ~ occupation, 'v?/7 Date of A c ~ f/' ,/r Location, . . If ,.tinjure ,n ,.,, st a wI,ere, d M /t,r/TA ~~ 190 7 Time dl-; ~ (J) Y/Y"i • Entry No /_ '#7 Mine No. / v_,., '.,/ • u, r < • Room No. ,:l, -~ // · , 'tYV""1J. • / .,,,_ 0/t /;) ~ _Name of Mi F,orma11, /(}~ !I/J. (i'~ Name of Mine Supt. ~ ~Age of person injured, r.5",/ ,z,J What ram//y, if any, // 11 • Mamed or Single J' ~ 1 How tong in employ, of Co., / t?:f ~ _ / • Co11d.t' • Name and address of nearest /iuing nefa/;ue, ,an of life or Circumstances, Was he an efficient man, Where and in whose oharge left, Name of Physician called, if any, Name and P. O. Adresg of Witnesses. Nature and extent af Cause, L,/,/_ ~ ~ ~ &L~ ~ ~ ~ 'i?~ ,,..._...,.._ ~ . k ~ ~ ~~ (Signature) Date t I Mine No. •••••••••••••••••······--········ ~.f/J.{l~ • Title, ~/Cl ~~ �20 FOl'lll 123. THE UNION P ACIFIC COAL CO. Mine No........................................ . REPORT OF PERSONAL I NJURY. 8up'ts No.................................... ~ ~ ~~~ " Name of Person injure~t:v?Occupation, d-~j(_,t._.--r Date of Accident, b / _ / .f~ , I Location, ~ /2 <Y,, If not injured in Mine, s ate wher , ( P([)~ ) m~ 7 Time / e:i: 1lo ~1"' · 34 o~r (}Jm. Mine No. 9' { Rt1M f) Entry No. - - - Room No. --- - ~ 1/~ · 0- m~-c.a: Name of Mine Supt. _,,6...,_,.J.. ~ - Name of Mine Forman, (] • Age of Person rn1ured, ~ Ma"i~rJ ~Single What Family, if any, / ._ __, , / How long in employ, of Co., / I' f f ~ • Condition of Life or Circumstances, Name and address of nearest liuing Relatiue, Was he temperatr?, Was he an efficient man, Where and in whose charge left, ~ . Name of Physician called, if any, e,,,// - Name and P. 0. Adress of Witnesses. NatureandextentofAccid~ 1 ✓d (Signature) Date C-7-IG·<Xl••GII. 1 /2,.,-,- ,n., ,/I/r £,J �r,-1".T'fS STATE~rµJ." OF WITNESSES. fl .I I 1;; 'I. �1 'flIE lTN 21 Form 123. roN PACIFIC COAL co. __ Mine No. ........................................ (·,R1' OF PERSONAL INJURY. RHf>,, 8up'ts No................................... a;;, -1 Person injured, C2v tl'""#. ."j-/{ ;j;--~ . flame 0'J / /~ occupation,_;,1,..J ..2 " > ~ ~ ,,,, oateo/Ac~-a, ~ _1907 Time / O ~ t : 2 , . 77). Location, . . / ~ Cl Mme No. ~ Entry No. ~7 Room No. c:ft, . If not injured 111 Mme, st te where, /4 e,t y~I{)~ Name of Mine Supt. Age of Person injured, o.2/f J What Family, if any, " How long in employ, of Co., Name and address of nearest living Relative, Name of Mine Forman, /'(().~ Married or Single J/ ~- ~ Was he an efficient man, ~ 9PJ!!fition <Jf Life or Cir~umstaJces, ua,e,., U ~~ /1~u,-) /;>./ §f~/ Where and in whose charge left, Name of Physician called, if any, ~~ • . v' fas 'J1 ljlnperaJ~•.14 ~ W;frj~ / f i J ~ d ~~~ /j <f:{~ ~ ~~? - vi~ I Name and P. O. Adress of Witnesses. Nature and extent of Accident, u I • I (Signature) Date 1 �OF W1TNESSES. ST,-\.TEMEN''fS �22 Form 123. THE UNION PACIFIC COAL CO. Mine No......................................... REPOT?T 01◄' PHRSONAL INJURY. 8up'ts No................................... . (J Name of Person injured, Occupation, ~~ ~ a , ,M_, ~-_ ~~~ Date~fAcojPJ:Jit,~~ / . , 2 , ~ location, l,(;;--c;,'J"' ,,,,,...;::r""/ ~ • If not injured in Mine, s ate wlufra,/ 4--~;;J~ · Name of Mine Supt. Age of Person injured, What Family, if any, ~ J:/ &AV1--T9 • f?7?/ 1 1907 Time ¥,'/J-<{) ~ Mine No. t/. Entry No . / ~ ~ 0 0 1 1 1 No. ,2-(J ~ ~ /'j) k · Name of Mine Forman, fllarried e1 Oi1191"1 ~ J/J ..Y/;?~ ·condition o ~ L_ori fCircumstances, i. How long in employ, of Oo., y' Name and address of nearest living Relative, ~ ~ ,if~ . ~ ~ iJ... Was he an efficient man, .a~!'?tempera_te, ;f £..Q..Where and in whose oharge left, ~ ~ ~ ~ ~ } l , , ,. Name of Physician called, if any, _,,,, / / ~ f>L? {!J[,,,;.;:;;/'v~· §:/ Name and P. 0. Adress of Witnesses. Nature and e x t e n ~ t , ~ (Signature) Date C•7• lu·tl3· -011. 7 h.-vr:/J '-- ~/4 Title, #v)11' t:'J ~ ~ ~. �Form 123. THE UNION PACIFIC COAL CO. Mine No......................................... RBPORT OF PERSONAL INJURY. Name of Person injured, 8up'ts No..................................... ~ ~~ Occupation, ~ vk~ • Date ~f Accident,o FF/C, /i i i 190 7 Locat,on, C1/rA .,.,~1 w~ . Mine No / • If not injured in Mine, state w ,ere, Name of Mine Bu~t. ~J//e:J~ · Time f' @/(¼.Jr ti m. Entry No. //,?.;?~Room No. Name of Mine Form~n, ,,p~ ~ Age of Person m1ured, oZ ~ ~ Marned tH 3: .. gfs: What Family, if any, /. How long in employ, of ao., ~ ~ Condition o~ Life or Oircumsta c s, Name and address of nearest Jiuing Relative, I ~I 1 Was he an efficient man, ~. . . , , , . . . , / ~ ' A ~ . Was he tempe ute, , •• • 1 Where and in whose charge l e f t , ' 5 f ' ~ ~_., k . £ ~ ~ Name of Physician called, if any, Y-M~, ~ ~ ~ &/. ~~ ,,,,3/~ Name and P. 0. Adress of Witnesses. Nature and extent of 1!;)ident, ../':.)! ~ Gause, Date C-7-15·03··011. 1 ffe(/4 . £ LZ,A.-'L,QI • •~ ~ ,a- ~~ �Form 123. THE UNION PACIFIC COAL CO. Mine No. ........................................ REPORT OF PERSONAL INJURY. 8up 1ts No..................................... Name of Person injured, 4-, &:cdtA?t- Occupation, ~ ~ ~~~ • DateofAccidenJ:7 -~~~: / ~ 790 / Time ,,t · (/?'7JJ .(/J~ Location, ~ I ~ 1 W;::14 Mine No. J Entry No./~ 4¥-Room No. /Jrrr-/ , If not injured in Minr, state where, 4.e 13~. NameofMineSupt. Age of Person injured, What Family, if any, ~ · ~~ ti{)· ~ ~ · Name of Mine Forman, Married 9'1' 9i 1g 'e How long in employ, of Oo., / / ' i j ~ • OoJY!.!.tion otJ-i(e or Oircumsta,';ft;s, ~ Name and address of nearest living Rera/;ue, 7?;J--,..-o 7 ~ ~ Was he an efficient man, Was he tam,ierate, Where and in whose charge left, ~ • NameofPhysioiancalled,ifany, /)cJ ~ / tx-~ ~ dJ~de,,d .f:J~ ,.,.,,,ff~ Name and P. 0. Adress of Witnesses. -4-42-r-~r. Nature and extent of Accident, (Signature) Date C•7•lu-03--0II. 7 p // , ef;p. ~ ·' ~ / 4 ~~ �'N,rS OF WITNESSES. STA1'El\1E J. �t.-, 25 Mine No........................................ . Form 123. THE UNION PACIFIC COAL CO. REPORT OF PERSONAL INJURY. 8up'ts No.................................... ~ ~ Name of Person injured, Occupation, . ~ Date of A c c i ~ q 1 r . 7 p/.,:. /?// 790 7 Time ..3 @ 1 ~ 1 {J) Location, r ~~/ W~. Mino No. I fotr-y Pkt. tPu.,, ~L~oom No. If not injured in Mine, state where, ~7/"'! »?. ,,8~uJu. ~/2~ · Name of Mine Supt. Name of Mine Forman, Age of Person injured, 0 3 ::f ~ · Married fn' Sh!g,1e What Family, if any, ~ How long in employ, of Co., - ~t ~ o n d ' ion of Li· or Oiroumsta;]JzJ, / Name and address of nearest li°/)1J Relative, ~ , ~~ ~ ,,-_p_,"7'_,,~..,/1...-~ ~~ Was he an efficient man, fjf~ •/ h //) f Was rnr e, ~Where and in ~~ose charge_ left, ~ $,o ~ ~ ~ Name of Phys,c1an called, if any, ~ !/ U ~ ,,,,,,_.,.-~ · i:/e,:;, ~/4~ / Name and P. 0. Adress of Witnesses. Nature and extent of Accident, (Signature) Date C-7- 16-03--«m. 7 �~l~d J., ~ g;,n~__.,,,u ~ I n],v,u , nv d, ~~ P-vt,, ~ -4 £:.I~ p/ J .d ~ m~, ~ t,{. 0: ~ r:P~ J ~ ~~ ~I~~ ~ f ~, ~ J. ,;4d ~w./ hL ""'YI ¥ ar,,v ~ ~ a-,,._4 ~ ~ f f ~,,,&_, . I I I �?tC l> Form 123. 'l'HE UNION PACIFIC COAL CO. ,a----,/\) Mine No. ........................................ REPORT OF PERSONAT~ I NJURY. Sup'ts No.................................. Name of Perso11i11jured, ~ ~--~- -a::_ occupation, ~ d.-, P?2 Date ~f Acci<j,ftfy /} ~ . . z , )- ' ~ 190 7 Locat1011, ~ / . Mine No. If not injured in Mine, sta e where, Name of Mine Supt. ~; { j ~ 7 ':Jf ~ • Time / .-<t?,,,6. (}~ Name of Mine Forman, Ma,. iul Gr-Single ~ Age of Person injured, oi,,, • What Family, if any, ✓ ~ Condition o Life or Circumstances, . How long in-employ, of Co., Name and addr~ss of nearest liuing tre!&tiue, ✓M ·1:r7,u~•_,c___, tf:11#-. 1 Was he an ejjic1e11t man, ~~ _ fr. /u Was he te,r,perate~V , Where and in whose charge left?" /~~ ~~- IJ.A/'"Z&r/.-__,._.,~ /,v--o--,~, ,,-&(~ '70 ) Name of Physician called, if any, ~ Jf4' U ~ ~ -;,_7,_ 'J.!, • --01 ~;4L,,,~ 'if -~ •// Name and P. 0. Adress of Witnesses. Nature and extent of Accident, ~ ~ ~ ~ @~ ~?ff~ Cause, ~,, ~~ ~ If, t1?. ~ ~ µ,;;.J~~ (Signature) Date C-7-t:;•<.O· ·llll. 1 Aai;~ Title, ~I 77J~vt, J~~ ~ �STATEMENTS OF WITNESSES. �__.. Fonn 12.1. ,gfi UN(O~ PACIFIC COAL CO. 1 -· - - RR / Mine >ORT OF PERSONAL INJURY. 27 No......................................... \ Sup'ts No... ............................ ... Namo of Person injured, 1 t...t :/, ;", ~ { ~~ ~~~~ • occupatio11, 7 oate of Accid~ - A F - " ~ ~ o 2 ~ 190 7 Location, ~M',,,t t h , ~ Mine No. If not injured ,n me, s a e w ere, c:P ;-,/J_ Time o<!,J / t?I Entry No. ~~f &7 Room No. / /f • .JI.~ NameofMineSupt. Name of Mine Forman, Age of Person 1111ured, ~"r' What Family, if any, How long in employ, of Oo., / / 0~~1itJJn of Life or Circumstances, 11 Name and address of nearest liuing Relative, ,;e1;.' t..f. N , £ ~ I ~ , ,.,__ ~ . -~.7 ~ Was he an effioient man, tJ:/'£<u // 'was he temperate, Q1 ~ • Where and in whose charge left, ~ .,./~ • // Name of Physician called, if any, ~ ~~- ~~e ,J'/~r-C2/ • ~ Name and P. O. Adress of Witnesses. ttl I If, ?• wvt, Nature and extent of Accident, J.. )tlf,r I { r ~l y· l (Signature) Date C-'1-IG•OO·•UII. 1 µ ~ ~ ~~ /1 Title, -d'-1/ �STATBl.'>1ENTS OF WITNESSES. �......--- 28 , Form 123, rilE oNION p ACIFIC COAL co. --- J?TWOR Mine No. T OF PERSONAL INJURY. -------·-······---- ••••••••••• 8up'ts No.................................. .. perso" Injured, ~~~ Name 01 ~~ occupation, - L' vtfc"~ ate of Accide ~(, 19o .,._...,...._., /Jh Time / ~:' 3,-p a_. ~ D • 7 Location, , Y.f///d,v • Mine No. ~ ' "'/ • If not injured in Mine, sta e where, _,..,,,,I ~ • Entry No. S / lwoo1-N-rr.- 7 Name of Mi1Je Bupt. . • 7 ~~ c2/ / ~ Age of Person m1ured, What Family, if any, £~ ---1 1u~ . Howlonginemploy, of Go., o2,J/2 Name and address of nearest living R latiue, was he an efficient man, Where and in whose charge left, Name of Physician called, if any, Na me 01,.(: Mme • Form ,, ~n, Marrred • ~ • ___, Condition of Life or Circumstances, ~~Sf L-,::";:•'42-. ,JI~~? I ~ ; , - ~ ut;J· I Name and P. O. Adress of Witnesses. Nature and extent of Accident, Cause, (Signature) Date ~7/2~ 1 • l ��· 29 ; Fo1·,u l:!.1. PACIFIC COAL co. -- T OF PERSONAL INJURY. J-{fi vrnoN 'f Mine No. ........................................ RIWOR 8up'ts No.................................... ~~ -~~C/C:d~ ,.; Person injured, Name 01 ~-,~---- n..-v't..occupation, ,,.,,;,,,.,,.,,, _/ f' v/.. oate of Accid_pj, ,, ,; ' • ~ 190 7 Time / tP (!Y~~ ~7) Location, ~ J / ~ · Mina No. / Entry No. .....5'"/ Room No. _ _ a. If not injured in Mine, ~here, Name of Mine Supt. ~t{J}/4c,.I{ • Nnme of Mine Forman, ,;(l/2 J~ Age of Person injured, ~ ~~ What family, if any, </A/vl--1 • How Jong in employ, of Oo.' .. <-5 ){ ~ • °).n~itio_n of lip or Circumstances, Name and addr~ss of nearest /,u,ng Re/a true, ~ / ~ ~ / cBr-c/,~~~ elftlJ.. was he an effic1e11t man, /7)_ ~ /J . Was he tempe~ale, ~ Where and in whose charge left, ~ ~ ~ ~ h i ~71/p/~ ·:F7 Name of Physician called, if any, ~ . J/W . <J1 ~~ ~ Name and P. 0. Adress of Witnesses. Nature and extent of Accident, (Signature) Date C-7-ll\•tn- ·CU. Married a, 8i1,yre 1 ,.«~ • I I ! �• l . ff,,=· f..•. 1:•:a'j p, 0. �Form 123. THE UNION PACIFIC COAL CO. 30 Mine No. ........................................ REPONT OF PERSONAL INJURY. Sup'ts No.......................... ,......... .7-".?~ <Jr,,,...,.._~~ Name of Person injured, Occupation, ._ ~r OateofAcc~~~ / Location, . . ~ If not injured 111 Mme, tate where, Name of Mine Supt. ;ff" ~ 1907 Time /c:? d 7.,-7, Mine No. / Entry No . .:Z-e/~HA/kom No. 43~ 7 -;r · ,,b'~. e ,,;L-/ .:t ~ -';('"' Name of Mine Forman, Age of Person injured, £, ~ Ah • ' ,, Single // What Family, if any, How long in employ, of (Jo., f' ~ Condition of Life. or <yrcumstances, Name and addr~ss of nearest living Relative, tn/"VM.., , ,, Was he an effiarent man, ~ ~~ pl Was he temperate, ~ / f;A!.../ • Where and in whose charge left, .Jtl~/'.J~ ~ -~ .-,v//7~/4-/tl./0 tf( 1 Name of Physician called, if any, ~ f ~ ~~ · ,, /4~ Jf ,fj Cause, Date c-1-1:;.03•• cu. ??J~ 6·d<f! �~EN'fS OF ·wr'l'NESSES. STATE ~· �31 Form 123. rrrE lJN[ON PACIFIC COAL co. - - -- T.)T Ofi' PTSNSONAL INJURY. Mine No. ...................................... RTWOt\ 8up'ts No................................ .. .. .; Person injured, ~ • Name 0" occupation, vA~ oate of Accid'!,P), / ~.2 S .~ ~ . 190 7 Location, ffri:,/;, ~ Mtne No. / If not injured in f,fi111', tate w/Jdre, -6?'~,L~ Nameo/MineSupt. Time t) Entry No. (p audnoom No. ~ k4 ,et::-~ ~ , f f ; } ~. NameofMi11eForma11, M1111 :Cd a, Single "J1 Age of Person 111jured, ..S-~ ~ What Fa milY, if any, How Jong in employ, of Go., . _ & ';!:( ~ 7ondition of Life or Circumstance~/ . Name and addr~ss of nearest /1u111g Relat,ue, ~~ ? J ? ~ , (~~~) ~ Was he an efficient man, L Was he tempi rb.t~, <JI~ • Where and in whose charge left, ~~ ,,/4/~v vrJ ~ , , t ~ Name of Physician called, if any, ~ G{,~ ~ . <!j ~_..,, . i/~1 Name and P. 0. Adress of Witnesses. Nature and extent of Accident, Gause, ~ (Signature) Date C-7-IG·W•-011. 1 11:-dr ~- �STATEl\1E.N'fS OF \VITNESSES. ~4~,~, »¾ / 5 ~/~lA?~ ~ : - ~ ~;;r ~ ~ ~. • ~ £,,j; ,,..~ ~vv4 ·---,-- ~ /t/~ ~ - . • ,z_,/°' . i j �Form 123. THE UNION PACIFIC COAL CO. Mine No.····································-··REPORT OF PRRSONAL INJURY. 8up'ts No............. ·--····-··-··-·-··--·· Name of Person injured, Occupation, Date of Accid'!]Jiy ~ ✓,,,--/J. r:-4LLocation, a;-z;/-c;;<J'~fj-0 Y-1/~ . If not injured in Mi111•, sfat~ ~here/ / ~¼ , / ,:}7/-' a. >?_? J(l Entry No. 3/ Room No. Name of Mine Supt. ~~/4--c,/r Name of Mine F:.:;~,£,~I. ~ Age of Person injured, ng e What Family, if any, How long in employ, of Oo., J ~~ // ~_(Jondition of Life or Circumstances, Name and address of nearest living Relative, Was he an efficient man, ~ . tf',__, Was he temper te, /J• <lyf ~ Where and in whose charge left, /'Q/'~vz_ ~ ~ Name of Physician called, if any, ~ {J,d:Cl-. . - #~ ff"~ Name and P. 0. Adress of Witnesses. Nature and extent of Accident, I 4 (8jgnature) Date C-7-lli·03•-Ull. 1 ~~ Title, -1f /# ~ ~~ �'I'S OF WITNESSES. sTATEl\1EN ,.,, . ... I,, �Form 123. THE UNION PACIFIC COAL CO. Mine No........................................ . RHPORT OF PERSONAT✓ INJURY. 8up'ts No................................... . ~~ O., LL . ~~. ~,?i!.:. _,,,.,~ 190 7 Time -2,,:" ~ Name of Person injured, Occupation, ,Pjf.., DateofAccideJlh Location, ~ ~ If not injured in Mine, sta e where,? / Name of Mine Supt. @~ Mine No. ~~ /c? Entry No. Room No. Name of Mine F o r m a n , ~ ~ Age of Person injured, / / Ji1 , • r , Single What Family, if any, How long in employ, of Co., d ~ • Condition of Life_or Circ~stances, Name and addr:ss of nearest living Relative, ~ i:;?~ ( ~ ) Was he an efjia1ent man, v"e./ • Was he temperate, ,9j' Where and in whose charge left, Name of Physician called, if any, C ,0_ . ___ . A ~ ~ L7 ~ - - : : : ( ' , c...:,,t[,,~ • Name and P. 0. Adress of Witnesses. Nature and extent of Accident, Cause, (Signature) Date C-7-Hi-0a--0II, 1 G~~- 'JI~ �"ENTS OF WITNESSES. sTATE~.1 ~ r' '. , . 'n . I • ~':I.... ' .• j �1 6)) THE UNION PACIFIC COAL CO. Mine No. ........................................ Rb'PORT OF PENSONAL INJURY. 8up'ts No. ................................ Name of Person injured, Occupation, Date of Acc~t, Location, t/w. If not injured in Min<', Time /~ / ~/~Cl>>??. Entry No. ~ Room No. ? Name of Mine Supt. Age of Person injured, What Family, if any, How long in employ, of Oo., ~ ~ ;Jndi~~of Life or ~i.rjumsta"fj:c s . Name and address of nearest liuing Relatiue, _L __ ~ ~--::rt/ . Was he an efficient man, • fl~ ~ • Was he temper te, ve/ Where and in whose charge left,' ~~~ • ~ Name of Physician called, if any, P ~ J~ JI~ Name and P. O. Adress of Witnesses. Nature and extent of Accident, Gause, •(Signature) Date C-7-li'>•OO· ·611. 1 j v~ Form l!!3. " �:_-35 Form l:!3. THE UNION PACIFIC COAL CO. Mine No. ........................................ RF.l'ONT OF PERSONAL INJURY. Sup'ts No................................... Name of Person injured, '0- ~ 4 ~ . oacupatio11, /.,,( P('"~v-?- (~~ ) Oate~f Acci<!:t1pt, ~///'. /\{}~ .. -?_/~ rno7 Time<-/ ttJ~ef ~ 1 Locat1on, t Y t ~~ ~<-J f,;; ¢'(/)f° · Mine No. 7 . . • If ot injured in Mine, tate where, Ent, Y No. ..3 Room No. ~ - - - t:c. 11 <} /~,47. Name of Mine Supt. ~1--£ . . Age of Person tnJured, a2' / What Family, if any, 't../ f; '7 Name oJ,.,, Mtne • Forman l'l ~ r --Q../ • ', • ~?VO /'l •, - ~ ~V (/4..,<2.,- • • • Mt1, .. 0tt e,-.Smgle How long in employ, of Oo., ~ tA- /?? ~ eond·t· • or 01rcumstances • , ion oJ,.,, life Name and addr~ss of nearest liuh1g Relatiue, -0.tf'~cL &•, ~ - d)_, Was he an efficient man, v;;./J e/ ..- temper e, ,,. ~• _ 1::/ £,--c:2.-,-- • t?, Was he 1 Where and in whose charge left, ffel/~~ ~ vt-€,/4.,d ~ v £~ Name of Physiaian called, if any, ~ t.,.-~ p M ~ r·j u ~ . c_ °4' Name and P. O. Adress of Witnesses. Cause, I' (Signature) Date 7 �,rs OF WITNESSES. sTATEMEN �{ l Funn 12:1. THE UNION PACIFIC COAL CO. Mine No. ........................................ - ---- -J?HPONT OF PERSONAL INJURY. 8up'ts No.............................. ..... Name of pe,s011 i11jured, ~ ,,de,,.,,,.C,,:4, • occupation, ~,v"M....ot4 ./f- /fJ , oate of Acci9J1t, ,,o/ . ',I 7?,l 190 7 Mine No. -;/ ,, ¢,{tt, / f~tJ--. Locatl·on, fMY:/1' ~~'t:/4-'~ v#,o/ If not injured in Min , state where, ~I . Time 0 7 y (t)!J&-uf" a. )lf-7;?. Entry No. ~ / ~~~' /41/ .3 .cc-~oom No. >'-'.Z a:::;_a 'J/ J~ . o/~d <Jf Name and P. 0. Adress of Witnesses. Nature and extent of Accident, Gause, I /II 'j/ 11/0 "'1 f I • I ~ j '\ (Signature) Date 1 )f:J, /} ~ ,.J • Name of Mine Supt. • Name of Mine Forman, :;,,:J'J. ff#, Age of Person injured, ¢.'1.._;;&MI"'--~. ~Single What Family, if any, ~ How tong in employ, of Co., ~ •.///7~ 'l./.1,d-.., • . Condition of Life or Circum~nces, Name and addr~ss of nearest liuing Relatiue, J~. was he a11 efficient man, ~ Was he temperate, ?:{- £,,e/ • Where and in whose charge left, ~ Name of Physician called, if any, ~ p,-? {!!,I:{ 0 ., / \ / v .l'---0. :1j / �"T'fS OF WITNESSES. STATEMEn • ,f �tHE (J N"ION i - - 'lJ) ~ - Mine No. ........................................ RT OF PERSONAL INJURY. O REI'\ c:.. I G_) ,_) • l!'onn l:l:J. PACIFIC COAL CO. i 8up'ts No.................................. . ,-1 0 Nnme'J $. ~ ~ vv>~ , Person injured, occupation,~d ~ ~-t'.: oatc of Ace, . Locat,on, • ,,Zp t/A ~ Q/ f , ~rr~~ tYl/...u,<;/J ,, ../f • I If not injured in Mine, state where, 4 ,;z>('If:/)~ Name of Mine Supt. Age of Person ~nJured, 7 / Time 790 N Ille o. M. ?,' ~ ~ ~ Entr, N '5 Y o. Name of Mine Forman~/12, £ _ ,. f1'a.1 ti& Single 7 '~ ':( ~ What family, if any, . / ~ - How long in employ, of Oo.' ~ d f ~vt?l'w...-oondition of life or 0ircumstanoes, Name and address of neares hu111g Relatiue, . Was he an ejfioient man, ~ J/ . /Mas I t ~ 1e empcrate, Where and in whose charge left, ~ ~ vv"~ . ,. Name of Physician called, if any, ~ fL? . ~ . ~ I • / 7 ~ & • Name and P. 0. Adress of Witnesses. " Nature and extent of Accident, I ,,,..I (Signature) Date Room No. e21# ...S-- 1 I d I' l �ivrENTS OF WITNESSES. STATE1·.1. I . I ''I.''' �ras ,T[ON PACIFIC COAL co. U 1-. ]?'El'ORT { - - - - Fonn 123. - Mine No. OF PERSONAL INJURY. 8up'ts No. Name and P. O. Adress of Witnesses. Nature and extent of Accident, Cause, (Signature) 7 ••••••••••••••••••••·•············ •••••••••••••••••••·•·········· �l,'orm 12:1. ~ tJNION PACIFIC COAL CO. REPORT OF PERSONAL INJURY. 'fHn ,. Mine No. 8up'ts No. N•"'' of person injured, CZ2z 7:o/$' 77] ~;fy ••••••••••••••••••••········· : •••• • •••••••• o n ~. occupation, d.._ :;:- ~.--<A:.oatc of Acct~de ✓ ,,, . oZ ,.,_ /?/1 190 7 Time / / I P ~ /:J Location, Jll"///,(/(1 • Mine No. / A . t I ·f V Entry N /_ /) J VV• :???-• If not injured in Mme, s a e w 1ere, o. c.? ~ Room No. ~ r, r ~ /4. ~ 02 Name of Mine Supt. c--/i( Name 0'J-F M'me rorman //J · · d ~~,<' ,,1//~ ,(} v"{/.' ~ Age of Person 1111ure , lP /?1 ~ ~ ., • _ 4//,;/, v·'"/ /1 y "/ Marned ~ -1e_ What family, if any, w~ cJ ~t'-U§ How long in employ, of Co., 0 ~ ~ Oonditi 1 L. Nam• and address of nearest /iuing Retdtfue, I ~ ~~·-::~•nces, was he an effioient man, <l,t 1/e/ ~as ; P r : , JU);:f~; Where and in whose charge left, ?'f ~~. as he temperate, 1::{ £--e.- "° Nr ) ~1~ ~ Name of Physioian called, if any, ,,,,,, Name and P. O. Adress of Witnesses. Nature and extent of Accident, (Signature) c.,.~-tu. &......-_ __ v ,....-; t 7 - ~'J'- Y,- 1 Title, /JJ / ~-U-a.- r ~ . �STATEMENT S OF WITNESSES. �Form ll!:J. NJON PACIFI C COAL CO. THE tli _ Mine No. ........................................ OF PERSON AD I NJURY. RF.I'OR T 8up'ts No. ············:·····............... . ~ ·" Person injured, / fcO_.e...,q tl'--1Y'-vd Name O'l. ~ A. Occupation, J~.,,.,L,, d...~ . oateofAc~ r:;r;:;-1 /'7 190/ Time /.,& ~ ( ~ ) Location, . . ~/ ~ • Mme No. J Entry No.o<!, &,a4,;;£nnm No. / ..:3 If not injured ,n Mme, st te where, • ~ e1/: Name of Mine Supt. J. . ~~~ /:JI~~ Age of Person injured, .::J What Family, if any, ~ How long in employ, of Oo., o& Name and address of nearest liuing Relcrt1ue, ~£ Name of Mine Forman, Married ~Biugle- rJf ~ · Was he an efficient man, Where and in whose charg~ left, Name of Physician called, if any, ~,~ ~ fj ~ l ~ Oo11jit'o11of Life qr Oiraum~a,naes,# . tH ) 1A7 ~ ~ /. I ~ . 141'~ _ Was he tampera~ , 6'e _ ~ ~( t!?<b~ MZ-, ~ ~-~~d ~ h t?t?-e,.,,_,.,.;,.J p✓-7 §/' ~ ;:z--y~ . Name and P. 0. Adress of Witnesses. ~• Nature and extent of Accident, . :; .,:, I ~-t. ;r ~~G?r~/7 Date Title, ~ ~~ I �STATEMEN'fS OF WI'l'NESSES. �41 1 I Forml.!!3. -rHE v~roN PACIFIC COAL co. i: Mine No. ........................................ _ nf OF PENSONAL INJURY. ]?lWOI\ 8up'ts No.................................... lI &: #_ ~~t;:o__.., ~ Person injured, 0 Name" / • . /~ , p-a,~e.,.., ocoupat1on,~ 0 ~ • oate of Accid t, ~ / 790 J Time /~ t t J ~ a,Yn Entry No. y' --'l'~oom No . • ::2-1, Location, ~~Mme No. f , If not injured in Mine, state where( t,?! . i Name of Mine Supt. , ,~ ( L I , , . , ! - ~ ~ Name of Mine Forman, ~ ::P'/2L.,a:{zt J. Age of Person m;ured, . . l ~ ~~ V ? " ' - ~ 17 Married gt 8ioyw. ff What Family, if any, t>'"v" .n-?..., ' How Jong in employ, of Go., . . ~ ~~ Gondition of Life or O{rcumstanc~ 4 Nam• and addreBB of nearest /,umg Relat,ue, ,P,?.Jr-c, /? ,Ip ~ ~ , o J,(J,, ,, Was l,e an efficient ma11, /1./ Was he temp{rate, _& <f"'. Where and in whose charge left, ~7/ Nam• of Physioia11 called, if any, !Y'1 (J.,f',:,--,-~- 4/~ ft~ . a · {, ~ Name and p, o. Adress of Witnesses. Nature and extent of A••:::r A ~ ff ~:::,Jx,, ~ ~ M I-- I 711.w.m~ (Signature) Date (.:.7 •• I',.((1•. 011. 7 tF"fm,,;,_,,.,~--Title, I I �412 Form l!!3. THE UNION PACIFIC COAL CO. Mine No. ........................................ RHPOI?T OF PERSONAL INJURY. Sup'ts No.................................... ~~ Name of Perso11 i11j11rcd, ~e--x. Occupation, ~ - ( ~ ~ ~1 v r ) AJ~~ Date of Accide')h / ~ C)~ ~ / 790 7 Time /0 JY/j. Looation, ~ $ ~ ~..;J:J· Mine No. / ~ n t r y No. - - - - Room No. - - If not injured in Mine, stf!te wherl, / e f " v ~ ~ ;_/ ./ftJ~ ✓- ~ ~ a. 4 ~ C. Name of Mine Supt. ~>{}AA. Name of Mine Forman, /'77Ai'#~ Age of Person injured, ~ "'21~ #a • • u, ·Si1'gle • ~7/ What Family, if any, 'l How long in employ, of Oo., ~ ~ (JPndition of Life or Circumstances, , Name and address of nearest liuing Relatir/4, ~ ,, ~,( • .,_ ) £.wr 1 Was he an efficient man, 91,,,£,,,e,/. . . Was he tem12erate. ~ • ~~ Where and in whose charge left, (/ Name of Phgsioian oal/ed, if any, ~~ . L . A - C / ~ / Y' (h{ • f-v-/ Name and P. O. Adress of Witnesses. Nature and extent of Accident, (Signature) Date C-7-IG·o:l··Oll. 1 ~ ~- L d, "J.L-1'.A/z.</l �STATEl\iEN'fS OF WITNESSES. f Ir• 1 ' I I .II r ..: .... Ii I I ,, �Form 123. THE UNION PACIFIC COAL CO. Mine No......................................... REPORT OF PERSONAL INJURY. 8up'ts No..................................... Name of Person injured, 7907 Mine No. Time // ~ t2.MJ. Entry No. -'/- .3 tJ1C.. Room No. 7 .3 Name and P. 0. Adress of Witnesses. ~ ~~~ Nature and extent of A c c i d e ~ ? Oause, d!) &. ·? I / , ~ l / -· ,,, f/ , ~ . _;. . I ,, / (Signature} I Date C-7•11">·03· ·0Jl. 7 ,r,-v ~:f �1''orm 123. THE UNI ON PACIFIC COAL CO. Mine No. ........................................ Rb'PON1' OF PRRSONAL INJURY. • Sup'ts No.................................... £!; Name of Person injured, Occupation, Date of Accid~n ~~c..,, ~• ~ ~,{J Age of Person injured, What Family, if any, · ~ ~ / 7 flt!:.. M. ,, 190 J . T· ,,me . Location, ~~, If not injured in Mine, s ate wherl, Name of Mine Supt. ~~e,()- Ill~ fJ"t-J.~fntry No. Name of Mine Forman ..3.S-;!/~ - - - Room No. - - -C:. ~ »"7--4fY'~ -;;1/-"' ,,,,,_, •• cu oJo 8mg 1e n11 9 - '. How long in employ, of Co.' ~~ ~Condition of Life or Circumstances, Name and address of nearest liuing Relatiue, <f Was he an efficient man, Where and in whose charge left, Name of Physician called, if any, JIJZ_,/ . ~ Was he temperate, . ";::I 'j;=1 ~ ;-., : , ;::j v-- ~ r ,~ ~ ve.,/ (¼ & Name and P. O. Adress of Witnesses. Nature and extent of Accident, (Signature) Date 7 -t ~ 77lff_,dC Title, ~~~ �STATEMENTS OF \VITNESSES. �THE UNION PACIFIC COAL CO. Form 128. Mine No......................................... Rl}PONT OZ.' PERSONAL INJURY. 8up'ts No..................................... Name of Person injured, Occ11patio11, Time J /@~4'~ Entry No. / ?'ZJ~Room No. ..:2./,Y Name of Mine Supt. Age of Person injured, ~7 ;f v ~ · What Family, if any, How long in employ, of Oo., / ~ Oondition of Life or Oircum;tances, Name and address of nearest living Relative ~ ~ ~ '-'-'.,,,_,,,,v Was he an efficient man, Wash; temperate. Where and in whose charge left, ~~ ~~ Name of Physici(].11 called, if any, / 7~..,,.~~-a,- ~~ ~ Name and P. 0. Adress of Witnesses. Nature and extent of Accident, Gause, t ~ Date C-T-ir,-o3. -611. l �sTATEMENTS 0 F \ VITNESSES. L ',• �Fonn 123. Tf16 u~roN PACIFIC COAL co. Mine No. ....................................... . REPORT OF PERSONAL INJURY. Sup'ts No................................... . Name of Person injured, (ii>¼ ~ ~~ occupation, 1/' / oats ~f Acci~~ ,;;:"~ ~ (/2 . Location, ~ ~ / If not injured in Mine, s te ~~1er J, 790 J vTime Mine No. d Entry No. ¥:;t- Room No. ?- ..3 ~~ £ /)(_,,7 ,:-,- ~ - /J~,... L Name of Mine Supt. ~ ~ 1 / U,.,~ Name of Mine Forman, Age of Person injured, t...? '3 Married o 9· ,gh, What Family, if any, How long in employ, of Oo. 1 Condition of life or Oiro11msta11 • Name and address of nearest liuing Relatiue, J{Jr ~ (2i1' Was he an efficient man, Zf~ / Where and in whose oharge left, ;,,r- /./'tlf-17'--,..'l,,<_,,,,.._Jj Name of Physician called, if any, c:e,r f l t I" Name and P. 0. Adress of Witnesses. Nature and extent of Accident, .. (Signature) Date C-7-15-00--ou. 1 Title, �·rs OF WI1'NES8ES. STATEMEN ' ,• ' r • �...r~roN PACIFIC COAL co. rfIB I.I... _ __ Form 123. Mine No. •••••••••••••••••••••••••••••••••••••••• of OF PERSONAL INJURY. J?Epo,~ 8up'ts No................................... .. 4~ ~ ; Person injured, Name 0'1 occupation, oate of Accident ..z,,( Location, . ,.,. t J If not injured ,n ,,,me, s e w iere, 7 • 7'7 ~ ~~ ~ / / 7BO M' me No. tf4}; ~ 7 Time 7 f #JJ Q J ~v: 'nf. Entry No. /J ~~ , R N oom o. Name of Mine Supt. Name of R1ine F o r m a n ~ - ~ A e of Person m1ured, M Jf ~ . • • :hat family, if any, # r t > ° / ~ ~ Marne (H 8i,,yfg 1 How Jong in employ,,-Fof ao.' t .,2/ 'l:f.£4v?'-O ~~atlkJ11dition o-F U-Fe o a· ,11' . ~In . ~ J J' r ircumstances, . S ,..,---:} 1 1 Name and addr~ss 01 neares rumg Re atwe, ~ ./ / ~~ ( ~I/{ £J L h 1 fl)-:!:{</. was he an ejfiorent man, (lt,rolf /'7/ , ~ Was he temperat/. at~ • '\} • I 1 Where and in whose charge lef , ~ Ok • ' 7/ r ,, Name of Physician called, if any, /~ ¥ Name and P. O. Adress of Witnesses. Nature and extent of Accident, Cause, l l I I ! (Signature) Date C-7-l!HXl-.ou. 1 ~) CJL~. I �~N"'S OF WITNESSES. STATEME.i: J. .·I �-4◄ 8 Form 12.1. r fII; oN[ON P ACI FIC COAL c o . -- J{EI' OR Mine No. ....................................... . T OF PERSON A I , I NJURY. Sup'ts No.................................... ~~ ~~ ~ ~~) nam• of Person injured, occupatio11, oatcoJAocid~, L Location, ~ I/,~,,,,,,._,,,, ,, pp;.__ / ~ ~~ If ,ot injured in Mine, Nam• of Mine Supt. ) .:Q" ~ ~ 190 Mine No. J Time 7 & & ~ d['. ~ Entry No ~~ rln~r te where, fJ - 1 - _,, No. / • ~tfifJ~ oZt7~ What Family, if any, P ~ iY'7 .2, , ~ e 5r Married ~ /4 ..ff-:.' - Name of Mine Fo;m a 1 1 ~ Age of Person m1ured, /JA. . , ~/ ~ • How long in employ, of 0 ·• ~~0°nd},ti'j] of Life or Oircumsta, ces Name and address of nearest /ivi11g Rela!ioe, -~ fl,;.., ~ Was he an effiotent man, ~- I ~J ' ~,;2/{,.:....,., ttJ,. Was he temp_erate, ti~ -~-? ~ ' 61('~ ( ~ ~ Where and in whose charge left, f4L~ ~ ~ J ~,,, 7! Name of Phyeioian oa/led, if a11y, • '7f" If ..f!J I>" ~ Name and P. 0. Adress of Witnesses. Nature and extent of Accident, 'I , 1 ~~ ~ ~ d ; : - ~ ~ ~ L J ~ Cause, d,,t,~ ~ ~, ~d~~ ~ , ~ ~ 4 ~ ~ti~ ~ I (' ~.~~~, ,d,~ ~ vi· µ7~ ~~ ~ /'YV~ ~ ~~~~~?Zl-. -~ 1 ~ -~ 7~ - ~ 1 • u~~ d ~ vrd ~~~1~~~d·,\. '' ~~\/ot 1/ .. Date C.T•l~·GO, (Signature) ~~ Title, 7 ''/ ~~ c#f m-lY~~ , I �lVl"ENTS OF WITNESSES. STA TE1·.1. • . $ #I~ .,;c ~ {];-,,,,U/r-4C,:-a__ ,d_, / # ~ {f ~~ /f,,, / -1 ~ - .A'"?t/ d r,~ /,d~,v~ 4t 7 ~ d~ ,,µ. J, ~ ~ ~ ~ --¥~ f d, ~-difl~~ ~~ -~up, ;r ~ ~ ,,.-c ~? ~ • ~ ~ 7f;~/0~ p �rrr6 I tyNION PACIFIC COAL CO. 1 _ _ ____ . _ 491 Mtne No. r.>T OF PERSONAL INJURY. .................................. RHpO,\ 8up'ts No.................................... ~ ~_,d~ ., person injured, Name o, n ). - # • occupation, ~ ~ ~~ ~~ oate ~f Accide';}v ~~ /_V / o/J. . 790 7 Time ~ , ..2-t:? -4""- ~ Location, t / ~ ~ P l / ~ • Mme No. ? Ent ;n ,;e./. • /Jnotififured in Mine, st where, {/ / -<J ry No.cf' "~Room No. ~ hL~~,, t fl/.~~ . Name of Mine Supt. ~'\ - ' ~ Name of Mine Forman, 7:J{. '\• Age of Person injured, ~. Ma med • ctr CH:::!sffll1it/E" , .Sittt1a: What family, if any, :.1 How tong in employ, of Oo., . . . 5 ti & {-1fr-o Oonditio~~ie or o·1rcumst ances Name and address of nearest /Jumg Relat,ue, ~ • ~ ~~ J was he an efficient man, <ZI -/7 /). ,A, / ~?f • tt:-, vvas 10 te, perato .~ • ,1 Where and in whose charge left, b f / ~ ~~[.-<.-,,,C/ir:<./L __,-~ ~ ~ Nameof Pnysieian oalled, if any, ,ff/• ____ y ~ ~ 7 i Name and P. 0. Adress of Witnesses. r µ ~# ~ f Notureandextentof A c o i d e • ~ f f . ~ k ff Cause, , (Signature) Date 7 . m -@ ~ ~ j' ~ • Title, ~m~4- �, , OF WITNESSES. S1'ATEMEN1S �. ,rJIE l i 5{) Form 1::1. r~noN PACIFIC COAL co. ---- Mine No. ........................................ 07' OF PERSONAL INJURY. REP0 " 8up'ts No..................................... ,-F Person injured, Name 0'J u' occupation, d. oate of Accide')J:; h ~ '. /-2 '.)/A 190 •7 Time Location, ~r ~ f::/t/_;;J<J • Mine No. / If not injured m Mme, sta where, {/ Name of Mine Supt. ~~ Age of Person injured, ,;vJ ~ . What family, if any, How long in employ, of Co., .//' < Oon~ition of Life or Oirc~_Janc_,es, Name and addr~ss of nearest liuing Relatiue, ~CA,,/ ~~ UL,-~. was he an efficient man, ~ £. W~s he temperateT -~~ ~ Where and in whose charge left, ~~ ~ Name of Physician called, if any, • f7 /Y fj rJ~) , ,Jr~ Name and P. O. Adress of Witnesses. (Signature) I ) l_f I , Date '/ 1 ~/4~ ~ �STATEMENTS 0 F ·w rTNESSES. 1 t ��S1'ATBMEN'f8 OF WI1'NE88ES. ,. �Form 123. THE UNION PACIFIC COAL CO. Mine No......................................... RBPOR1' OF PERSONAL INJURY. Name of Person injured, _,,...,~ Sup'ts No.............................. ,...... ~~ - Occupation, ~ Date of AccidJ,f), _ 6 ~ 190 7 Location, a::,,-dr:,~~_/7~~"'1/ ~ • Mine No. If not injured in Mine, state wh e, Name of Mine Bu~t. • Age of Person m1ured, What Family, if any, ~~ 7 cf' &e-?.:/r t2-/'??. ,,<£kA!{ JI./? Entry No./ - Room No. 1 ,,, . / ~ -r- ,,e_ ~4&, Name of Mine Forman, 1 • Marrie~: • ~..:2--~ t#'.dv Y & ~ , Time r How long in employ, of ~ 3 ~ - Oonditjflp of Life o , E cumstances, B o · d/ -~ Name and address of nearest living Relative, {/d~} ~ ~"' Was he an efficient man, ~ . #!_ Was-I e temperate, ,,,1 cit., Where and in whose charge left, Name of Physician called, if any, ~~ ~~ / J /J (7 "A/1"::&:_.,-,,.__.r,,~!r--"'1'. Name and P. O. Adress of Witnesses. Nature and extent of Accident, r (Signature) Date C-7-tr.•03- •OIi. 1 �Form 123. 'l'HE UNION PACIFIC COAL CO. Mine No. ........................................ Rl~I'ORT OF PBRSONAL INJURY. 8up'ts No .................................. . Name of Perso11 injured, ~ ~ ~ ~~ Occupation, ~ Date of Acci~, ✓~-~~~ /_C/ ~ Location, ~ / ~ If not injured in Mine, st e wher , Name of Mine Supt. / 7907 Mine No. ~~ / Time 7 / / tJ ~ Entry No.,t, Room No. / Name of Mine Forman, /2, ~- 4/, f k,,-Je,,(2.,,;f::- _, 1 Age of Person tnJured, ot,jl 4 ~ ~~;e· What Family, if any, // How long in employ, of Co., ~ ,2; tl{J...ed~ Condition of Life or Circumstances, (2/f. ~ , Name and address of nearest living Relative, ~ /~ ~ vz Was he an efficient man, ~ ~ ~ Wa~he t- mpera{e//✓ ~ dk) Where and in whose charge left, ~ /QI~~ ~ /f V ~ , ~ - #~ t:f!i, 0 Name of Physioian called, if any, .Jr~ Y ~, Name and P. 0. Adress of Witnesses. • Nature and extent of Aooident, ~~ d ~ -¥-~• I Cause, (Signature) Date C-'i•lu•0:!--011. 1 /4d, Title, ~~ I 1 : �s1'ATEMEN1'S OF \VITNESS ES. ( .· �Form 123. THE UNION PACIFIC COAL CO. Mine No. ... .................................... R.EJ>QR1' OF PENSON.AL INJURr. 8up'ts No.................................... Name of Person injured, Occupation, ~ ~~ ~ 7~ ~:::t~:,~cci~ If 11ot i11Jured ,n Mme, statf'where, / 7 ~u -/ Min:::. 7 Time ;::,/;:. ~7:7 Room No. ~~~ Name of Mine Supt. Name of Mine Forman, Age of Person injured, c-2/7'~ • ingle What Family, if any, 4 How long in employ, of Oo., ) ' ».J~.t..,Candition of life or OircumsJance_;~ Name and address of nearest liuing Relatiue, . ~~r (/;~iv;--) ~ /if",1J Was he an efficient man, ~ ~ ~ Was !J,,.;mper. ~e, ,_f/f,xZ/ Where and in whose charge left, ~ __,=-~~, r ~ d , , ~d'1'tr. Name of Physician called, if any, / /~~.,,,..-z,,,L,,"M' P M,o___.,...-?'1-rv ~,,7----,,;:;,:.,,,.. • ~ a /. ~ ~ Name and P. 0. Adress of Witnesses. Nature and extent of Accident, ,.' Cause, Date ~ ~ ~~ ~ / ~ ~ /¥ - ~ - , �STATEMENTS OF ·wrTNESSES. �Form 123. TfJE UNION PACIFIC COAL CO. Mine No. ........................................ J?TSPORT OF PERSONAL IN] URY. 8up'ts No................................... Name of Parson injured, ~~ occupation, oate of Accid , nr,,_,__.,,,,,..,.., Location, If not injured in /11inr., s ~ 6 -/ /4- _. 190 / er~ Mine No. Time 7 3/ t!P??/ Entry No.~~ Room No. o2,.,3 ~ Name of Mi11e Supt. Nama of Mina Forman,~,;,A-"L<,__ Age of Person m1ured, . ~f Married~ ~ , '-"' - What Family, if any,~~ pP_ , ~ ~t--?(.....-How long in employ, of o., ~ / /I?~- ~011ditio11 of Life or Oircum~tances, . ; Name and addr:ss of nearest ltutng Re / a ~ ~ ~ ~) ~ A - - ~ / /?n:,lf Was he an efficient man, ~ ~ If_, ·Wa;(e-tamp rate, ~ V _;r-. Where and in whose charge left, ~~ &..£,-'YVrv-rd,, Name of Physician called, if any, - (I )>O l _:.,,n.-,:~fl:/7/ •.,,,..=- _., _::r~ ~.)f/r, .fl~ Name and P. O. Adress of Witnesses. • Nature and extent of Accident, Cause, (Signature) Date 7 ~ )f-74~ Title, ..:;# J ~ /a}~ �STATEMENTS OF \VITNESSES. .' :, �-- J ... [ Form 123. 'fflB u~ro.N p ACIFIC COAL co. , -.~ H ~_y • -- Mine No. ........................................ . >ORT OF PERSONAL INJURY. J?}',l 8up'ts No..................................... N•"'' of Person injured, ~~- ~ occupation, oate of Acaide!)lJ; ,L.., • Location, ~ 1 If not injured in Mine, state where, / , ~~ • ia ~ . 190 7 Mine No. 7 Time ~A · Entry No. - Room No. Pt? Name of Mine ~u~t. U,£,,,f-A"~~r Name of Mine F o r m a n , # ~ ~ · Age of Person tnJured, ~ i1f • ti c:: Single What Family, if any, /-:} / ,,L i /_L How long in em.ploy, of Oo., ~ / }f??~Oondition of life or O i r.c ~ ce~,m s t Name and address of nearest Relatiue, d:A2/ ~ ~ ~ ~~ was he an efficient man, ~ . tt,,,. Was he '!J?_!!J)<lrate . e-<eWhere and in whose charge left, ~ ~~ fY7~ Name of Physician called, if any, /. f ~ r~;] 'Y!l ..fl~ Name and P. O. Adress of Witnesses. Nature and extent of Accident, I ,4)1 Cause, Date I. �STATEMENTS OF ·wrTNESSES. .. ,I . ~ , �r.- rJJu 5·7! Form 1!!3. UNION PACIFIC COAL CO. ---- Mine No. ....................................... REPORT OF Pb'RSONAL INJURY. «~ rict..-- Nam• of Parson injured, '--/? occupation,. oate of Acc1de'W) '1:j Location, ~-,,, If not injured ,n Mme, stat o2/.t:?~ / . / Nam• of Mine Supt. ~~ ~ ':!;!J , 8up'ts No..................:................. ~__/4,.,::../( ?:?7 190{/7 Time // ~ r::7-> 1 flt ine No. I Entry No.~-1/~~o. Name of /Jine Forman, ~ ~ /4 Age of Person mJured, 0 ~;Jf ~ · Mm • ., "'' Single ./1 What Fam~ly, if any, J .. . How tong 111 employ, of Oo., ~ /4Oond1t10~ of Life or Oir';)f!Jstan;,!;~s, . Name and address of nearest liuing Relatiue, { J . / ~ / ~rl. :Jf · was he an efficient man, ~ • ~ a s he temperate, Where and in whose charge left, vv--;y~ ~ Name of Physician called, if any, / ~ ./ /J Name and P. O. Adress of Witnesses. Nature and extent of Accident, ~~ ~ ~ ~ ,--u.,,,, ~,~~/~- Cause, (Signature) Date 1 I �sTATEMEN'f S OF WITNESSES. �~ REpOR ;.~(~) Form 123. -...TroN p ACIFIC COAL co. 1•HE {J.1..., (J,,,JJ O _ __ Mine No.··•·-···········-----··················· T OF PERSONAL INJURY. 8up'ts No..................................... i... \ --.). ,.; Person injured, 11ame o1 occupation, oate of Accide':b _~ Location, p(/77// t . ,iured in Mine, stat If no 111J /4 ~~ ~ ,z;- ~ ~ ~t./4/G, -;;;, . 190 7 ; -¥ / ~ • -(, ' ~ / J (/),e?,r-c4f {7.),77/. Entry No. 5/J Room No. m.~-1~- t Name of Mine Supt. ~~ ~ Mme No. Time Name of Mine Form~n, Mamed c 8 g!B Age of Person injured, ~~ What family, if any, ~ll? - ~ · How tong in employ, of Co.• . . ~ ~ - Condition of ~ife or (Jircumstances, and address of nearest !ruing RelattUe, ( ~ ) ~ y:;::::;>- • h - / dYrfo, /J,A ~ . was he an efficient man, Where and in whose charge_ left, Name of Physician called, if any, JI~ 11.,.. 01/::::ftl . /cl~l~ Nature and extent of Accident, Cause, (Signature) 1 f;/ / (:/'7,,-. /~ ~ Name and P. o. Adress of Witnesses. Date ~ / ~ p VII.'. she emperatc, ~ - ~ �S1'ATEl\iEN'.fS OF WITNESSES. �f.''' ~ 't, 1<.J 'u Fonu 123. ~roN PACIFIC COAL co. fJ·J» tJ.. ----- Mine No. ....................................... . RT OF PERSONAL INJURY. pIWO . . • (• )~ 1.. ,FPersoninjured, Name 0'J Sup'ts No .................................... ~O-~~ '7' • ~ occupation, . (!}e, ~ oate of Accj;n~~ .;1 ' " ,.,,ation, (1,rV'' / t • ; red in Mine, ate wh e, t ~) ~ . 790 7 ~. •t . •. If 110 111'J 11 I Time Mme No. /(? ~ CJ~r a),. // Elltr N Y o. c.3 Room No. P-o/. /,,,,:2,/ ~ ~ Name of Mine Forman, /1 / £. . ,, .< /7 ' o-,./J/ b ;y f)'~ ::, jJ· I/ Married ~~~ Si 9 I ., U,C,/. ~~' r ~ What family, if any, v'V'-}-- a---rif ~ ~ • f:!_ How long in employ, of Go., ,I'::JI~ . Condition of Li e or Giroumsta I,,, Name and addr~ss of nearest liuing Relatiue, ~ 7:17fa _ ""~~ ~i >f. Name of Mine Supt. "\.· Age 01,FPerson1n1ured, . . • • //,{;/, A ~ 1.1"- ' ,,, ,,as he an efficient man, Where and in whose charge le , ~ Name of Physician called, if any, • t@t" -~·Z..;-r~ ~ ~~ • Nature and extent of Accident, Cause, (Signature) 1 r / Was he temperate, /7 / Name and P. O. Adress of Witnesses. Date 9,- ....,.,.- , b ~ :q- ,......- l • 1 ti)~• ~ �STATEMENTS OF WITNESSES. I .·/ ,, t �·raE p,KTON PACIFIC COAL co. Mine No. ........................................ RlWORT OF PERSONA]: INJURY. Sup'ts No....... ....................... .. Name of Person injured, Occupation, ~ ~ oate of Aocide;Jy ;,~£ /~ Location, ~• , ~• If not injured in Minl', st . e where, Name of Mine Supt. 1907 ~~ Age of Person injured, What Family, if any, How long in employ, of Oo., oZ Time tf Mine No. _,,, ,r- Rnar ~ No. ill 1 , '-4:.'.cr Single ~ ~~ O~ndi~O,Aof Life or Oir<J_umstances, ~ ~ ( ~ ) dJ.-w'(~ ~ ;ff' ~ . Was he an effiotent man, Where and in whose charge left, Name of Physioian oalled, if any, ,,. ~ . . lf~ Nature and extent of Accident, Cause, ( ,v '\ \,/ (Signature) 1 Was he temperate, /"'(Q,... . ~~ . Name and P. 0. Adress of Witnesses. Date Entry No. Name of Aline Forman, ..o ; : / ~ Name and addr~s• of nearest liuing Relatiue, ... o 0 0 ~ ~»? Title, ff~ · -; �, 'l'I.! OF WJ'l'NESSES. S1'.\'l'I~Nh.N ° ,, ,I. �u~nONr PACIFIC COAL CO. 1•Jln 61 I Forinl!?:I. T:' Mine No. .. ...:................................. uT OF PERSONA!,, INJURY. irwo,\ 8up'ts No..................................... ' '/ ~~ ~ ,; Person injured, /1:tnlBOJ• 1 occupat1011, ~A 4, Loct1tiOII, !,_, ffnO t . ifured in Mine, /fl ( ? _• • n::; ./ ,~ . f/f_ ~ tZ,,a1:r ,./ ,.,,....,,.,,_ ~5 ) ~ oate~fAc1/f:J/" ) • -~'6 'llte where, /!_, ,_ ~ ~ / .I ~/f. . v~ • . 1907 Mme No. Time J? 0 ~ t:c· >"?/ / t::? Entry No .3 Room No. ,,.2-,...5 • ~ ~ t/7~ • Nam• of Mino Supt. 7,-,3 Name of Mine Forman, Age of Person m1ured, I/' ~ Married .; Q' , : What family, if any, ~. How long in employ, of Oo., ~ ~~ Oo'JJ1ition of Life or Oircumsta;1ces ~ • Name and address of nearest liuing Relatiue, ( / ~ ) ' ~~ ~ JH · Was/lean efficient man, ~ . AVJP~ Bha t mperala, tf~,J-✓ ...--. / Whereandinwhoseohargeleft, ~~ ~ ,n~ /f Name of Physician called, if any, ~ ~ ~~- ( , \ ~ ?. Name and P. O. Adress of Witnesses. NaturoandextentofAocident,( ~ ~ P"" ~/?--~ ' ~ ~ ,,~........... Cause, ~ ~ /. ~ \ ! J I (Signature) 1 Title, ~ ~ :.,w{ ] ~ ,. • {1 �Form 123. THE UNION PACIFIC COAL CO. Mine No......................................... REPORT Ol•' PERSONAL INJURY. 8up'ts No .................................... Name of Person injured, ~~ -c/ ~ · Occupation, Oate of AcciJl!jit, , j ~ ~ _.} / Location, ~ ~ lf not injured in Mine, tate wl,(re, , Name of Mine Supt. Time Mine No..- - Entry No. - - - Room No. 1907 ~- ~A!}~ Age of Person 1n1ured, What Family, if any, Name of Mine Forman, ~..;JP,?'~~ Married e s· 9 '11 o Z ~. ~ //1 · How long in employ, of Oo., ~s - / ; ? J ' ~_gondition of Life or iroumstan°}J~, _ Name an'd address of nearest liuing flelatiue, ~ ) ~ j l - ' / A ~ ~ ~ • / Was he an efficient man, flJ. £:<2,/_. . =,,/, Was he temperate, Where and in whose charge left,7/ ._ d L? /J Name of Physician called, if any, AAIJ'-?A~' ~ •~V ~ · m~. <J Name and P. O. Adress of Witnesses. Nature and extent of A o e i d e ~ ~~ ~~ ; r Cause, (Signature) Date C-7-lo-03--0ll, 1 �STA1'El\1EN1'S OF \VITNESSES. �Form 123. TBE UNION PACIFIC COAL CO. Mine No. ........................................ REPORT OF PERSONA!, INJURY. occupation, _,,,,, • at oate of Acci~t, ,,,"!J'#;;P'; 7 Location,_ ~ - < / If not i11Jured III Mme, state wl re, ~ Sup'ts No... ................................ ~ 7 790 Mine No. ~. ~~~ Time f m ~-~ Name of frfine Supt. Age of Person injured, ,;utf"~ Name of Mine Forman, Married.,, 9i11gle What Family, if any, How long in employ, of Oo., oZ,,,~. /I v(A~ Name and address of nearest liufng Relatiuc, Was he an efficient man, (j/ ~ Where and in whose charge left, Oond~f Life oyl}j,;J!)'ms_tances, ~ - 0 ~ ~ / /t;nv,,11 ~ ~ --::::/ Was he temperate, .,,,, I,€,<Z_,/· ~ /t Name of Physician called, if any, Name and P. O. Adress of Witnesses. Nature and extent of Accident, 'I Cause, (Signature) Date 1 m ,)ti, ~ Title, ~'J~· �STATEMENTS OF "WITNESSES. �o)i Forin 12:J. tHE UNION PACIFIC COAL CO. Mine No......................................... nonT OF PBRSONAT✓ INJURY. J?B, i\ Sup'ts No................................... . Name of Person i11j11red, ~~ • <--v<~ occupation, ~ oateofAac~·d, ~~ v ,,z,2///·--<-~ 790/ Time /:J .,, .7 tO~-dr v.-'/::?)'. Location, . . a / vv-w_,,.1 Mine No. / t::J . .c--r Entry No. '-" Room No. If not injured tn n?mfJ, la te wIier , erp- .-ti~ { ? ~ Name of Mine Supt. ~ , 1 { J ~ Name of Mine Forman Age of Person 1111ured, ,;2,-~ v 7 - - < Q M -~ ~ 8 . 5• What Family, if any, ~~ ~./?{; ~ . Y ( _ , ) arr, "' How long in employ, of Oo.' f' ~-e.~ ~ J e1dition o o-1' ,,-1". a· t 'J . 1,18 0 r 1rcums onces, Name and addr~ss of nearest liuing Re!atiue, ; ~ ~I Was he an ejjfotent man, ,✓.,- 1ie t emper<fte, /. Wa: '2,-j ~ Where and in whose charge lef , ,✓,, Name of Physician ea/led, if any, n..o !f~ . ,. h - ~ / ~ _ § { ~ a -.r;r£~. Name and P. 0. Adress of Witnesses. Nature and extent of Accident, l I' ' Cause, I I• ! /l Date 7 �Fonn 1:!3, ,uB UNTON PACIFIC COAL CO. 1 / . '' Mine No. ........................................ RJrf'ORT OF PERSONAL INJURY. ~)Je./. Name of Person -Htpll!l!:JJ, ~ 8up'ts No.................................... ~ '¼~r, ~ Pal' ll.1 0 ~ P ~---&/7. occupation, . / /J -:-_f ?2z-;,,l,.,(,,/t,...oate of Aco~d1••ft E /~ (1 ///I 7907 T,·me .J: ~ (F ~/?/. ,, Location, . . ~ v'V~ Mine No. 7 /12 If 110t injured ,n /Jme, s tc where(/ ' _., Entry No. J; C: rlt'/,,,&1,om No. ,;zt:? SNnme of Mine Supt. ~~ . ~/ Age of Person injured, . . //~ / ,,:::::, Name ,, M' 'J //J / •~ / F, ~ me orm~n, Marne . • ~~,//7 • , ~ ./~ . -r What Family, if any, V"V'~ ~~ < W ~ ~ How long in employ, of Oo. • ~~~7?7n~ondition .~ L;-r. a· · 0J 1 . . • Je or 1rcumstances ,,,($ ) Name and address of nearest lw111g Relatiue, ~~ ~ t:I!:;; --71 . ~ ~~ , Was he an efficient man, ~· / ~ nv ~ ~ ~• 1 . .,,- Was he et 11erate ~ Where and in whose charge left, ~~ ~~ ,, // e,,,e, Name of Physician called, if any, ~ :a Name and P. O. Adress of Witnesses. NatureandextentofAccidd~~ / Cause, d7J-~;g,,, . / ' /I . ~ . (Signature) Date 1 eL~ £C �,,.r,rs OF WITNESSES. STATEMEn �Form 123. r:T-r.- UNION PACIFIC COAL CO. 'f ,:i,s • - - Mine No. ........................................ NHf'ONT OF PUNSONA TJ INJURY. Sup'ts No.................................... , . . d Name of Person m1ure , ~/ ' ;4~ /j> ./~ occupation, ~ f7I-... oatcof AccideytJ Y,~6. / ~ 7 Location, ~ P~ ~ If not injured in Mine, s te wher"d • • / --c., C?'l ~~ 790 7 Time .3 ( { J ~ 1 {?~ Mine No. /~ · Entry No. --<, Room No. /t?~ 7,:.7,~; ,~ Name of Mine Supt. ~tf{p../4~ Name of Mille ·Age of Person injured, ,3 ,f • •• ingle What family, if any, How Jong in employ, of Go., / /. - 0 ~ Condition of Life or Circumstances, Name and address of nearest liuing Relatiue, ~ ~ tV6- it!=~., was he an efficient man, ~~ ./,.(. , L "(,/Was he temperate, ., ry ~ Where and in whose charge left, V~~ /[)?~ ~ ~ - .// ~ Name of Physician oalled, if any, ~ µ7 {;,,,4:,,,.,,-n/4~ - JI'~ c/J~ Name and P. O. Adress of Witnesses. ~ ;_.u ,j . Nature and extent of Accident, 0 44. Cause, ~ ~(/r~!f (!,A/~ / V-V( . / ~ ~ ~ ~1~/~ ~~ (Signature) Date 7 47L -~ ~ ~ 1· �~ r:- vNtON Fo1·1n 12:1. PACIFIC GOAL CO. 1•ll.-, Mine No. .............. . J?l';f10NT OF PERSONAL INJURY. • ! IE [Teo.ION ,. \ l ' l l' JI I c,., vu. •1 • I . Balance on hand yeslerd - -~ =-= ay:.:_ · - - - - -Collections made today, viz: Rent, Electric Light, and Water, _ J-/ I o t: i - -\\_ __ _ - -~ ~ ~- - __2- ~ ~ s __ co_al_. - - -- - -- - - 1 - - J i i i ~ ~ I _ __ T_r_,rnsportation, - - -- - -- - - - - 1- - _ _Material __ Sales, _.:___ _ _ __ _ I! ~ . 11-----! Ground Rent, j ___ , I ! - - - - --1=--· _\ 1-- ----------- - ----= = = = = = ---=--=--= --· -=== - 11/f} j LJ.· I hereby certify that the al This report must be made up at the close of each day ( except Sunday r ( (Signa ture) 1 II I II l I I ' �,.......---1·t16 J J?&POR - - - - - 6 ~? F orm 123. oN [ON PACIFIC ~OAL CO. - Mine No. ·········-·--··························· T OF PERSONAL INJURY. 8up'ts No..................................... ,; Person injured, /4-a~ (/ameo, occupation,_ /-2, d_ oateof Acc1de~ ~ ,~ , / Location, ~ / ~" . .iured 111 Mme, sta ~ where, If 110t /IIJ ~ ~ ~ ~ £ . ,- · 190 7 Time Mine No. /cJ @~ · ~([}d:n:/r (l?71/ Entry No. 3 Room No. - ~ ~ Name of MineForman,~/0~ - m1ured, ~ IJ ~ ·V - ~ a,msoJMineSupt. ,., Person Age 0'I ll cJ ~ What family, if any, How long in employ, of Co.' "it /f . Mamed • - • • ~€-?1_..,,. . ~ ':°--f;:.,,}/ ~9ondition of Life or Oiraumstanaes ~ Name and addr~ss of nearest ltumg Relattue, Was I1e an effic1ent man, P'/J.. Where and in ~~ose charge_ le t, Name of Phys101an called, if any, ~ ( ~ ~~ / ~ ) Was he temperate ..t,,., • P-v;::r~ / lj ~ $c,--<»L ~ Jf~;::r y,,CJ r, • / $2,$,v /I (e;'~. Name and P. O. Adress of Witnesses. I_ Cause, 1, I I I I, (Signature) Date µ,~ . Title, 1 /7 ~CJ'~~ �F orm 123. v(\roN PACIFIC COAL co. fJJ6 l Mine No. •••••••••••••••••••••••••••••••••••••••• oT OF PERSONAL INJURY. p6I'O,, 8up'ts No.................................... .1 11ame o, person injured, ,). {/'- occupation, /f ,1 Accide9J9 ~-4 oate o, ~y' Location, . ft). ~ • G.--11'~ /•o2 . If not injured ,n Mt ne, state where, ~co/~~ 190 7 Mine No. / //A /t/~ r . "•ameofMineSupt. · · d~~ ~ L'5t : , . A of Person m1ure , ""7" • O :hat Family, if any, tfif'~ Time o '7J1 . A //J ;-/ v'c/4-vl'r <.r En try No. Nameo•-FM' 'J tne Fiorman • , Room No. ...3 k f-1 ,. • ./ / -,-_ • ~ Married•• 8i •• •~ ~ ~~ How long in employ, of Co., -v'°'J~',-t/~'Jf ~ ~ o , ~ of Life or 0ircu Name and address of nearest liuing Re ue, m~tance) i L )~ w,, h• an efficient man, ~ e..-<e./ c/f //}. Whereandinwhoseohargeleft, Nam• of Physician called, if any, ~.µ ~ ( . £, c,,~~ / ~ a ~~ ~ ~ P" (I ~~ , 1(/,,{.,_ ) ~as he te11fperat~ • ' , //L~ . v;::::::r I Name and P. O. Adress of Witnesses. I' I I ,4e} ~ ~<-4 ~I Nature and extent of Aooiden~, @ ~ d- -2 £,,._J,,,/ .; L Cause, Date _ __ _. c..lf-liH.Q•.011. 1 I ~ �("9 Form 123. , ~ P ACI FIC COAL CO. •116 v;-.10 _ __ t['~ ·~J Mine N . 1 0 ··········.............................. T OF PERSONA L I NJURY. NfS/'08 8up'ts No.................................... ., person injured, Nc1me o1 :,i occupation, /f,OtW)I Time 4 ( f } ~ / e,, Entry No. v:)._ 190 / n1 ine No. o,te~! Aooi~~ Location, . · ,red in Mint, st te where, ~ Na•• of Mine Supt. , Person .ul}ured, ,.g ~ , 8 01 ~ v Name of Mine Forman, (?n/ . Room No. 0 //A rfJ~ ~ -Mr "" • I • C. Stngle• .., w11at family, if any, HoW long in employ, of Co.' ( /o/_ ~ Condition of Life or Oircumstances Name and addr~ss of nearest /,u,ng Relatwe, &~ ..J/ / ,,, 111as he an effio1ent man, _;;t <J,,f vQ..../ . ~~ Where and in whose oharge left, Name of Physician called, if any, (/ fi/✓• /Z:-vl/~~ • q. ~o l {/ vvas '" / t perat ~ ~ ~ ~ H~~ ,e e1 f/ .... t?-~ ~ ~~ • Name and P. O. Adress of Witnesses. Nature and extent of Accident, a . , , / ~ 'J' / ~r P"' ;,. = ,Ia'j,f •,A--v ,., / tf',.,,.,/4 Cause, (Signature) Date ()_I/(~ A-JV~ Title, 7 e~. (! c.:::7l.,.-; -,;I 17 1 j ~ ~ I �Form 123, raB UNION PACIFIC COAL co. ---- · - REI'ORT ~ Mine No......................................... OF PERSONAL INJURY. Sup'ts No................................... , Y ;()) -~ 1 Person injured, 0 f/ame'J ~ ~ occupation, v-AA~~~ oateo.ifAccid!J?}, ~~~ .~f:..e,,-;a . 79~ Time ij"rfY~, tP.:MJ. Location, ~ J / ~ • Mme No. / t? Entry No. t:...? Room No. If 110t injured in Mine, ate whe , Name of Mine Supt. ~~iqf}_,/4,c,.,1:;, ~, ~ r ., /.:f§' &,/.-<2-rY\.... Name of Mine Forman, .tJ Marriecl «es· 9 't Age of Person m1ured, #// . - ' ~ .,.. / - A What family, if any, t?f/+ a-z.-r~ ~ How long in employ, of Oo. , o2 -0 ~ ~ n d i t i o n of life or Circumstances, Name and address of nearest liuing Relatfffe/ .Y..?Jr. ~~~ Was he an efficient man, L /Was he temp r a, . ~ Where and in whose charge left, P l / ~ .,,,..<5/~ Name of Physician called, if any, • ~ ~ c...,,z.,,,,,A.-;.AJ,r.,..., -~ .,._ ..,--=- ,ft~ ~r,a~ . Name and P. O. Adress of 11/it..m,.., ti{/+ . 4 ~ ~ ~ , d!£,,/c:,,,,,,-/ea_.,~ Cause, (Signature) Date 1 �...T PACIFIC COAL co. F'onn 123. rJIE UN 10•" Mine No. ........................................ ,r OF PHRSONAL INJURY. JtEWO}\ 8up'ts No................................... . ,1 Perso11 injured, ,0~~ 0 N«me" ~ occupation, ~ / 4 2~ ~ oate of Acc~.:t Y ~~ Location, / ~ • •n,iured i11 Min,•, ate whc , t f/110 I~ . ~ '- -YL-, V-f,,-,r. 7907 Time//<{}~ {Py-,//. fl/me No. / ~ Entry No. 3 Room No. , Name of Mme Su~t, ~~/4-c.,/C Name of Mine Forman, ,I@. ~ . Age of Person m1ured, ~ ~Ingle What family, if any, tf? How Jong in employ, of Oo.' ~ ~ Cji./1dition oyife or Circumstances Name at1d address of nearest liuing Rc/a(iu;, ~ ~~ f df~ ..J ) ~I~~ ~ was he a11 efficient man, ~• • L., Was fie tcn;J?cyte, ~~ (f' I Where and in whose charge left, ~'VIA-~.,, _,,~..,.,..,__-u - a / ' ~ ~ / j ~ . l Name of Physioian called, if any, _,..,,..,.,,, 7"7.A:,,z..,1'--"''1- --pC' ~ .. ;J1 V - Name and p, O. Adress of Witnesses. Cause, II l I I (Signature) ~ 7 ~ Title, II I I �Form 123. THE UNION PACIFIC COAL CO. Mine No. ........................................ REPORT OF PERSONA[., INJURY. Sup'ts No..................................... Name of Pmou iujured, 4. ~ . Occupation, . F/.... ?/../4,-n vr., oateo/Acoidey!J /_2 / ,.£}__~~ 1907 Time 4 ( f 2 ~ cP.WJ. Location, ~ ., ~~. Mine No. / v' Entry No. Q Room No. - - - - If not injured in Mina, s te where ~~~~ /2;-/JI'· ~~~ Name of Mine Supt. Name of Mine Forman, Age of Person injured, -¥~ • Married @J' Sh113f-e. What Family, if any, d"'- ~ How long in employ, of Oo., / ~ ~ - // /??~ , OoJ)P_ition ojAife or Circum~tances, , Name and address of nearest liuing Relative, /?/2'0, ~ -CL':;~. ( J{A~ ) ~~ Was he an efficient man, ~' . /4 i/ tias he temj)p,yte, . ~ ~ - - • -, Where and in whose charge left, ~rJ"'7/j c,-~ '&v-v'-1 .,,,(0.,,.M,.,V~ <'/1'-#;"Vk~ Name of Physician called, if any, __./, f /<Zf t,"' ~ &,~ r · ~7 Name and P. 0. Adress of Witnesses. Nature and extent of Accident, Cause, I Date C-T-15-03--ou. 7 I �FOl"IU 12:l, TI-IE UNIO~ PACIFIC COAL CO. Mine No. ....................................... . RBPORT OF PERSONAL INJURY. 8up'ts No .................................... Name of Person injured, ./ ~ ~~ occupation, of(._ /7 7J'2~r~ e---r cJ oateof Ac~i<!fJ1t, /,,2,; ~ f:f/~~ _ 7907 Time /-/ tfJCCtc?~ I/:'/~/Location, W _-w(~w~-r~z--tAKJ/ ~ . Mme No. / t:J Entry No. -3 Room No. - - - If not injured ,n Mme, tate wh e, ~~~ r Nqme of Mine Forman, µ (fj;t{:;[;;z,,-7(, Name of Mine Supt. Married er g· g' Age of Person injured, ~¥_,_ / · A . / What Family, if any, ~~ ~ / How long in employ, of Co., / ---.z.-- "}7 ~ Condition of LiferJr Oiroumstances, O /J~/:__ . Name and address of nearest liuing Re(a{iue, ~~~ ~ / ~ L ) U:~1 ~ v < - - - - ~ . Was he an efficient man, t2f&,<l./ . . /.,. Was he tempfrat~. . r&f €A/'· f 1 Where and in whose charge lef(/ $;:Jfr;,,-Yl,,.,,-t/vi-:1 /&'~£,,z,,,d ~>1-Jv"tJ;i;? Name of Physician called, if any, (/ 'Ir' ~,,.,,?vr-~---< _,,"J'J Name and P. O. Adress of Witnesses. ., Cause, (Signature) Date C-7-ltt•03-•Ull. 1 �F orm 12.1. THE UNION PACIFIC COAL CO. Mine No................................,........ ]?8PORT OF PERS ONAL INJURY. 8up'ts No..................................... Name of Person injured, ~~ ~ ~ ~ ~ occupation, v6, oateofAcc~t, (~;/A -~~ Location, ~ -6f~ e.,/ ~ . If not injured m Mme, sgt; where(/ . Name of Mine Supt. 4-<~~ ~1{'. Age of Person tnJured, ~ ,; 4 What Family, if any, ,,,.,U ~ How long in employ, of Co., ~ ~ / C J ~ . Name and address of nearest liuing Relative, ~ Was he an efficient man, ~v0 • Where and in whose charge left, Name of Physiaian called, if any, ,, Time ¥ 0 ~ {7!nJ. 7907 Mine No. / t? Entry No. 3 Ni:,me of Mine Forman~@ Marrie :r g • Room No. - - - r:;z>~ Condition of Life or Circumstances, . _ . Y'?-7rYf e v/ / f - / ~ --rm,,, ( M~ ) / Was he temperate, tZf V'<./ • I ~ , /&-4, /J \ • \ I Name and P. 0. Adress of Witnesses. I I I I I I I Cause, (Signature) Date C·7- 11Hi3-•Gll. 1 �Fonn 123. THE UNION PACIFIC COAL CO. Mine No...............................,........ . REPORT OP' Pb'RSONAL INJURY. 8up'ts N0 . .................................. .. Name'o/ Person injured, µ & ,_d -~a:A"""u-· occupation, . ~ n/4--yc...,;G.,-"C..,...-,~ oateofAccidjJ), (~ 1907 Time , ¥ ( t l ~ !7?7-77. Location, ~ / ' { } ~ / ~~ Mine No. / t? Entry No. 3 Room No. ' - - - -If not injured III Mme, sfate .where/ , .d Q -61A, - ~ ~ - Name of Mine Supt. /4,,.~,{j,/~ Name of Mine Forman,u4. • Marrie w 3 'ii {7J ~~ Age of Per~ on ;;1ured, €_-' : .e.~ ~ _ # . / or What Fam11y, I; any, ;?vvn:,--. ~ How long in employ, of Oo., /6 ~ ~,~ . , Oondition of Life or Oircumstanoes, Name and address of nearest liur;;J Relative, ~ ~~ ( 4x_, ) ~ ,{Jt,1./TA....-.~v~ Was he an efficient man, t1.de,.e, · ~ a she temperate, ;:-1 / /). , , Where and in ~~ose charge. left, ~~ .,., . /4"t1'-0~ • Name of Physician called, if any, f ~ pef/ f"~V&.~v Jf Name and P. O. Adre,s of - d,tf_,, jl..,_., &e.,;{, 4 .( J§:.,..,_/~) 4-~ ~ f ~ NatureandextentofAccide~J~ 'r , L I! J II 'l I Cause, (Signature) Date C.7-1~-o:i-.uu. 7 �rfIE oNrON PACIFIC COAL CO. Rb'l Mine No . ....................................... . ,oRT OF PERSONAL INJURY. 8up'ts No .................................... ~ .; Person injured, ~Name 0" • • occupation, d ~L,- ~ oateofAccide97) /f:rt;1/ -~~ 790 7 Time ,y(//~,,f Location, ~ ~,1 ~ • Mine No. / t? Entry No. ...3 If not injured 111 Mme, sta where, f M (;2!~. Room No. u- ~~~ Naiiie of Mil1e Supt. Name of Mine Forman, ~ Age of Person injured, -:2-0 :ffi , • • Single What Family, if any, How long in employ, of Oo. • ~dition of Life or Oircumstances, Name and address of nearest lrumg Relaiwe, }ft- 1"~~ (4-~,..) ~ ~ , Was he an efficient man, ~. IZ, Was he temperate, -. ~ .1 Where and in whose charge left, ~ " o /~ /Q/..,b-1/ ( . , ~ ~~ Name of Physioian ea/led, if any, f ~ P ~~- (;!/_ ~ , _}f Name and P. O. Adress of Witnesses. Nature and extent of Accident, .1 Cause, I I· (Signature) Date 7 �Form 12a. 0~ PACIFIC COAL CO. rfJl; vNr i - Mine No. ........................................ ,r OF p1£RSONAL INJURY. J?IWOI\ 8up'ts No..................................... ,ipcrsoninjured, pame o, []J,,, ~{/f./ /PX 6J ~ ~ occ11pat/011, oatco/Accidy}I, ( / ,1 • 1 1 Location, f{;<rt:4_ / 'nitired in Mme, ate whe , t tJ 110 I 'J Nam• af Mine Supt. k~~ ~ _,,, ~ ~ - Time ✓ ~ c:z:! Y;?? . / C' Entry No. ~ Room No. - - - - · - - - -- - - 7 190 Mme No. . v~ ~ / i )./4,:,/r Age of Person injured, .2 .SWhal Family, if any, ,,_ 1 How tong in employ, of Oo. I ~ ~ Oo~ion of Life or Circumstances, ~ Name and address of nearest liuing Relat.fue, ~ . , , ~ ~ ( ~ ~ ) ~ ( was he an efficient man, ~ ,L_,, Was !1e temperate, . Whereandinwhoseahargeleft, ~~ / ~ t f l { ~ Name of Physician oalled, if any, ~ P"' v' Jf JI . I Name and p, u ~. Jf o. Adress of Witnesses. Nature and extent of Accident, Cause, II I (Signature) Date 7 jllf~ Title, II::<; ,,,~ 7v L~~. __,;v, ~ - - - ~ I �Fonn 123. rJON PACIFIC COAL CO. 'fJ16 l ~ . . T Mine No. .. ...... .......................... , OF pEI?SONAL INJURl~. • pHf'OltT 8up'ts No.................................... ~ . ~ 190 7 Mine No. Time / t? c/ ~ Entry No. 3 /?/JJ7, Room No. I \ Name and P. o. Adress of Witnesses. Nature and extent of Aoaident, ~ ~ ~ ~ t:y v . ~ ~ ~ ~ n~. ~~ ~ ~ ~ ~ /?.--r...--u 1.. / % C V p ~, Cause, ' (Signature) 1 �Form 123. ~ -rr~roN PACIFIC COAL co. Jln "'• 'f - Mine No. ........................................ , OF PBRSONAL INJURY. ~1sl'o1\ r 8up't8 N0 . ................................... .1 Perso11 i11jurad, ,,.,mo o1 ~~ . occ11pat1011,. oateoJAcc~de, ~:3 L . ,//{>__ ~ ~::::7 ~ .c.&<:...fU-,t,e,,.J-?"'l. ?I _ IJ/1' J -{/1, Location, . . red ill Mine, sta where, ff not mJU t1am• of MiPB Supt. ...__J V' ,, ~2 'f/{/~ ......-1 ~~ 190 Mine No. ~ / Time ..y ~ (l!}~. ,.., £ ntry No. ..3 Room No . / v 7 Name of Mine Forman, {J_ t,v/. ~ Ago of Person m1ured, ///_;/, . ~ ~ .,... £7 .A ,, Married~ What Family, if any, t~'lh-p-,{/. I' ~ How Jong in employ, of Oo., -~ -,_. ~ ~ Ooid_!tion of or Oi~c~msta11ces, }j!J Nameandaddressofnearestltu1;;_}eraffue, ~- ~ . C/~~ ~r~~ ~ .: Was he an efficient man, 'j:/ ~) . _h ~as he tem eratf,_ ~ .v.,,,' Where and in whose charge_ left, ~~ / ~ .,,,,., .~~ Name of Physician called, if any, _,,,,,,,.fj~ Y ._,..,,,£/l.,......,"7'l ___,...~ . flame and p, o. Adress of Witnesses. r \ I 1 I : i I Nature and extent of Accident, Cause, i I I I I (Signature) 1 �Form 123. rf!6 uNTON PACIFIC COAL co. J?IWORT \ Mine No. ....................................... . OF PHT?SONAI., IN] URY. 8up'ts No ......... . ........................ ~ ~ 1 Person injured, name 0'J occupation, oate of AccidJI)• $' ~ -1{2,,6~-L-~ c : : 7 ~ ~,,Z I 7""'ij/2vv • Location, ~✓ ~ If not injured in Mine, s te where/ N,me of Mille Supt. ~ 11// ~ 790 J Mme No. ~~ Age of Person 1111ured, ~/J · What Family, if any, . Time --¥~ / t? Entry No. Name of Mine Forman, :::/:;-::JI~•,,, ./J '3 {?7?7. Room No. - - - - - ,RJ I " . ~ Marrie~..,,:e w+ ~ ~ ~ . Hoiu tong in employ, of Co.' .. ~_;:?/'~.Condition nf Li e or Circumstances, ,0 . . . Name and address of nearest ftumg Relat,ue, ,....~ , Ll.t'-,e,,-,.r-r.,v (~) ~ Was he an efficient man, .ft/~. Where and in whose charge left, ~~ L.. Was I,! l.emperate, ~~ o/~ ~ W f~ /J :--- r/ M.,, ~ l • V~· f ,,, Name of Physician caffed, if any, Name and P. O. Adress of Witnesses. 1 I Nature and extent of Accident, I' I., Cause, I \ I . (Signature) Date 1 p-tP~ Tille, .p/t7 ~ - �Form 123. 'flIB ONION PACIFIC COAL CO. --- Mine No........................................ . J?EfORT OF PERSONAL INJURY. 0 , person injured, ~-~ occupation,. 1 ontc ~! Acc ~ Location, ~~ / ~ .p,,( . 8up'ts No..................................... ., ,d._ 1~ / • t twhere, ff n,tinjured in M111e, ~ , ??-~ ~ ~ . 790{/ ,,..~ ---r • Mme No. ,_ / /4,,-~ Time -9"" ~ /~ C/ Entry No. 2- R N oom o, ~~ o,JMine8upt. Nam ,-,:M· fJ .,/J ff;) /<? e oJ me Fvrman, ~ ( / ' . , a - ~ Age of Person injured, / ✓o/~ ffi. • , es. Single What Family, if any, Holli long in employ, of Oo.' .J~. ~»2--tr-o • O<>mtion of life or;f)ircumstanc s Name and address of nearest liuing Relative, //77i;, ~ ( c:#.t z ) Was he an efficient man, ~A'~ ,,, 11e te')}e,ralt:, .,a,,. ,,,, // #/ 1 , £r vvas Cl-1,,~ Where and in whose charge left, VV;::[ t r : n ~ 1 1 / ~ ~ -Q~ Nameof Physician called, if any, ~ Nanl 8 ti -ti ~,,/,,,,__.,,__,, Name and P. O. Adress of Witnesses. I I I I Ca.use, I (Signature) 1 �THE UNION PACIFIC COAL CO. Mine No. ........................................ REPORT OF PERSONAL INJURY. 8up'ts No.................................... Name of Person injured, ~ ~. cf?/~-h.?<A '---C ~ ,,(..,L 2 .,L,/2::., ~ . ~ occupation, oate of Acci~t, ~ ~rt.--V/J. Location, ~ I ~ If not injured in Mine, ate where,# ~7w-,~ ~ 790 7 Mine No. ~ Time / v L/ ~ r rJ?777 . Entry No . .,;:z__, Room N o . - -- ~.r;u~~ Name of Mine Su~t. Name of Mine Forman, Age of Person tnJured, t?/I , ,,.2, #' /J Married G C' 1g$¢ What Family, if any, vt/~ ~ ~ ~ How long in employ, of (Jo., ✓? ? J ~ Condition of life or Oircumsta es Name and address of nearest living Relative, ~ I• • Was he an efficient man, ,J/6-e-. _£, Was heJeiypcrata,. . //,/{;:/ £-e-- • Where and in whose charge left, ~~ / ~ ~~t:;;Ct{'l Name of Physician called, if any, fl - o / ~ ~ ~~ 7 %r'~ _ ·,? 4Ar ~( Name and P, 0, Adress of Witnesses. Nature and extent of Accident, .., l Cause, I I I. I (Signature) Date 1 �Form 123. TFIE UNION PACIFIC COAL CO. Mine No.................................. REPORT OF PERSONAL INJURY. 8up'ts No ..................................... Name of Person injured, ~ )"1?7~ ~z ~ ; .v~ ~ - occupation, Dateof Acci&J!j, /f_,~~=-v.!:~...., g{j, Location, / / ~ ,,,,. ~ • If not injured in flline, s te where, 790 7 Mine No. Time > / 0 ~ / c; .,61~~~ Entry No. ---3 Room No. - - - - - -- /,If!~ Name of Mine Supt• Name of Mineforman, •• d ~~ ~ Age of Person 1n1ure , ~ ~ Married 01 e· g.'~ What Family, if any, :✓- h' How long in employ, of Oo., /~ ; J f ~ J;;;,o 1dition of Ute or Circums~ces, . ,,o . Name and address of nearest liuing Relative, ~ n-:?~~-t./:) ~/Art/It. (/A~ /1 Was he an efficient man, Where and in whose charge left, Name of Physician called, if any, ti., Was he ~n;))erate, . ~ $ ~ ~./'(/ ~ Y" ,? • 1 r, &--,e,,,,, ~- /; '\! 7 1., Name and P. 0. Adress of Witnesses. I Nature and extent of Aocident, ~~ ~ ~ ~ , , L I_ ~f~-~- ' I aause, • (Signature) Date 1 p-~ Title, ~t?~- I �Forni 12:J. TfIE UNION PACIFIC COAL CO. Mine No . ........................................ RJSPORT OF PERSONAL INJURY. 8up'ts No.................................... . i Name of Person injured, occupation, oate ~f AccidJJ1}, // -Y. Location, ~ If not injured in Mine, Name of Mine Supt. ~ ~~ . M f i ~ h~ ~~ ~ . ~'i(Jv "' ~ te where(/ • ~• ~~ ~ . 1907 Mme No. / / Time 4 ~ 0 Entry No. Name of Mine F:;man, • ::2-- Room No. If -tfJ~ Age of Person mJured, ingle What Fam,·tY, ,,,-F any, ~ -------~---------How long in employ, of Co. , ~ ~ Condition of !,ife or Circumstances, _ JJ ,-d.,_ Name and address of nearest living Relative, ~ V ~ ~ o 7 C _ ( c f ~ J ) ~"P/fi Was he an efficient man, ~A . tf',,. Was he temperate, _ .5f:t£--.e.Where and in whose charge left, t 7 ~ / c i : 7 ' ~ -d'(' D----Q,..,~ :::_:,- ._.. Name of Physician called, if any, ~ - Y::, '-P'c.-v---vr~,,.v • _5/ Name and P. 0. Adress of Witnesses. Oause, (Signature) Date 7 j-,,tll{l~ Title, --11-/t? ~ • I, +. i\ '1· I ' �PACfFIC COAL CO. ,aE UNION i: 1 - -- Mine No......................................... OR T OF PERSONA L INJURY. RnP 8up'ts No.................................... ., Person injured, Name 0'I /4 / ~ ~ ~ • occupation, ~ 4 A6~/4,...., ~ oateoJAccijJJ1t, t?·/ '° ~ - ~--- .,,.:H. 190 7 Time ¥ ~ - c / . r 1 Location, ~ ~/ ~ Mme No. / (? Entry No. - ---iR~oom No. If not injured in Mine, state whe,(J, ~ ~'MJ. I: ::::;~,~;:: ~::.~ed.~ Name of Mi11c F::.:~:~&e ~ What Family, if any, ~ - ... _ _ ~ _ ~v__:::::r----.-Hoiu tong in employ, of Oo., / ~ / / ~ ·0ondition of life or 0iroumstanoes, Name and address of nearest liuing Relatiue, Was he an efficient man, ~ Lt, Was he temperate, Where and in whose charge left, ~ .,,,,()/4,,~ ~ Name of Physiolan called, if any, _fj➔ Y, (!!,,1£,,,_.,. .-v-Y:h"--'="2__,, .J:/ . Name and P. O. Adress of Witnesses. Nature and extent of Accident, I 1\ I I I I I Cause, I I (Signature) 7 �F orm 12:1. rJIE uNrON PACIFIC COAL co. J?fif'OR \ Mine No........................................ . T OF PERSONAL INJURY. 8up'ts No.................................. . oF Person injured, N,1111e 'J / 17~~ ~ 1f ·.J:1' / , ~ d d~~~ ~ occupatio11,_ oateoJAccijjyt, J:'..Z, ~~..,._,,..,,_., Location, ~ ,-~11!/l~-<4;~_...1/ ~• If not injured in Min<', ate whe e, ~ v ~~ ~ Name of Mine Supt. A e of Person injured, g if What family, ' any, was he an efficient man, Where and in whose charge left, ,,,//, ~~ Room No. --- ~ Condition of Life or Circumstances, , f ~ ) ~ ~ t/£,,1,. _ I . ~ J Was he tempe~·atc, ~ .l...!(Z~v __5(""/- ,,,._J pO Name of PhgBician called, if ang, '2-- Name of Mine Forman~ Marrie a. €."..gla I How long in employ, of Co.' Name and address of nearest liuing Relatiuc, ) ~~ f?..7--?/ . 790 7 Time Mme No. / Entry No. ~ ,z,- / ~".;r ·~ . Name and p, o. Adress of Witnesses. / / Nature and extent of A c c i d e n ~~ ,:Z .,_,.__.,/ ~~ r Cause, (Signature) 1 JR·~ Title, t.r·/ v' ~ • l �Irorn\ 12:1. rJIE uKION PACIFIC COAL co. Mine No. ........ RHpORT 01" PBRSONAL INJURY. ~ of Person injured, 1101116 Bup'ts No.................................... (..A,c.-?-..,.....,__...-,,i,.__,_ _ occupation, oateof Aeoi~, , / Location, ~ ; . // £;. ,;zd, .,&,,,,(,✓ ,-=.,, _L.-__ ~~ ~tA,....,".,.,,,....,7".z;:fj""V 190 7 i· .,y' • ., t'f iwt injured in Mill,, ate where , ~ . ,= ~ v,_ Mine /lo. Name of Mine Supt. _ , , , , ~/ < i } ~ Ageo/ person injured, , 0/ / ~o?,'2-77 O ,me Entry No • ~'/ • ROomNo. - ,tJ / / ,{ (/'_! ~ 4.,,.~~ ~ .Z/ ~ '"" v7A' ~--= and address of nearest fiuing Re/at·we, Condition of u~e r 1rcumsta Name of Mine Forman Whal Family, if any, How long m employ, of Co., flame Was he an efficient man, Marrie~~' <2,f Whereandinwhosechargeleft, /! ~ 0 • ~'iy~,,..., lY(/-- #AA Nam,of Phgsioian called, if any, _;:;.r • , _"';,/ O ~ ie em, per·'te" J f j , n J' ~~It" • Name and P. 0. Adress of Witnesses. ~ •J:/. e,- _ • • , + • • ~/ / /lature and extent of Accident, I l I I Cause, ~ &-'.l:'.~~4} t><.'./7,,-r/ ~~~( l( (Signature) ~ 7 J-ifl: ~ Title, ,tr'/,?~~- �UNION PACIFIC COAL CO. rr1E . Form 12.'l. fi:) Q '! (; '-.J ' Mine No. ........................................ .! nT OF PET?SONAL INJURY. J{£P01\ 8up'ts No. .................................... Name and p, o. Adress of Witnesses. ii i· 1 I Cause, (Signature) 7 �ll'orm 123. rfJ6 vgJON__ PJ~C~FIC COAL co. Mine No. RfipONT OF PERSONAL INJURY. ••• ••••••••• 00 ••••••••• •••••••·•·· Bup'ts No ....••••••••••••···••••••••••••··· , person ;,yured, 11amC0" " d . • _.,,..., ~l./7vll'- / / ~~ ~~ ~ oecupation, · Ac ~t,i d oate of / ')/ "'°'"'• ,,#.,..,-_ ~ rt not iniured in Minr, s 190 "¼',-.,., te where, £,, . -"""' M" ---; - 7 / .,.. ~ ~ __ _ / /7-~ _, . ,1me -<-r / o £ntry No. me No. • e r~ Room No. ~ 1 ' ✓,;7' ,:ame of Mine Supt. / ~- / ( ) ~ /gt•/ person injured, //,:;. . f/,ot Family, if any, ~ ~ How tong in employ, of ao., / b_);/ ,v, ~ • Name and address of nearest living Melatiue ta, he a// effioient man, cy Where and in whose charge ~ re/t, ,.., of Physician oalled, if a11y, Name of Mine Forman, Married Oond't•101 ~~ 1 7(/~ I/./i • _ij~ _,, , v -~ f) ._tJt'/ /"Z)-✓- ~ •~ 1 • ms ances of Life or Oircu t (,<a ___ ,e , ,1perrrfo ~ a she t en,.,,, ~~ ~~ '1f;o ~ : ~ 1 u) d) ' ":' p-- e-£a--~ /.~ . /f· 7-Q._- Nomsand P, 0. Adrass of Witnesses. 1 / • ~~~ Nature and extent of Accident, Cause, I I I (Signature) 1 µ .(?~ Title, ,-1-/c, ~ - j I I I I. �r'orm 123. r JJE uNI ON__P:CIFIC CO AL c o . Mine No. ........................................ T OF PER SONAL I NJURY. uEI'OR 8up'ts No.................................... ll-· ~ .; Person injured, O flame" ~~ occupation, ,. / oateoJAcci/glt, (_.-2~- . d ~ac , I Location, ~ If not injured in Mine, Nam• of Min• Supt. . 790 7 f,!/me No. 4<~ - - - Time d { P ~ / e? • - - - .-3 Entry No. 0 Name of Mine F~rm~ 11 .Z / • • red• Age of Person lnJLI What Family, if any, n~ &-r ~ / • {?777. Room Nu. !{J -~ _..,rn__. -Single - - -::rr- / ~(}~ _O~tion of Life or Circumstances, I ~ (L:;;.-r~ (~ ) ~ r~ U/:tv- I Was he an effioient man, JI~ . ti., Was he te11JP~Ya _te, .1 \ Where and in whose charge left, ~ ~ %--,,,U/Z,,~ aj Hotu long in employ, of Oo. ' / Name and address of nearest liuing Relatiue, rl-"Vr,, 1 vC/ Name of Physician called, if any, Name and P. /J .Jf~ p d- ~. I' o. Adress of Witnesses. Nature and extent of Accident, /.)~ "'] ,'.'., aj'-IY .2 ,.__,,/ ~~~~ - Cause, (Signature) Oate 7 ~ r ~, I 1 II �Fonu 1::1. •~•(ON PACIFIC COAL CO. 1IJ6 Ll' . (' V. -· - Mine No. ...........·······················--···· T OF PERSONAL INJURY. J?SpOR 8up'ts No.................................... ~~ · · d' ,I Person uuure 11at11eo, . A d ~ occ11pation,. /Z &~~vA~>?-ZA1/J~ l90 7 Time 4" oate ~I ACC~r '/ • I Mine No. ,, o Entry No. Location, . .11red in Mine, ate where I/ not //1) ,.,. of Mine Supt. tJ~, 4~f ~ Name of Mine Forman, Room No. ,s- rJ. fl'. tZ7~ Jgeo/ Person ~njured, - - - - - -- Mi • • o~gle What family, if any, ......,_L . / Holl tong in employ, of Co.' t:, / / ~ . Condition of Life or Oircumstan es ~ q ~ ~/~ Nameandaddr~ssofnearestliuing Relatiue, was he an efficient man, w,,e,e and in whose oharge left, ~• Name of Physician called, if any, , ~ Was he te - • - - R/i. .. . 7 ~l l / : . ~ ~~ ~ '.:!J'P-0,/,(~ 1' (/ ,,,, o / ~ pO ~~ Name and p, O. Adress of Witnesses. Cause, (Signature) 1 µ~ Title, 717~- I �STATEMgNTS OF \VITNESSES. �F orm 1!!3. rus u ~10N P ACIFIC COAL co. Mine No......................................... ,r OF PERSONAL Il-.1.JURY. ]?/SI'O}\ 8up'ts No.................................... ~. 7~ ~--- .~ Person injured, ,,..- , ~,__~<./'-' 11ame O" l ~ ../ occupation, e,-1.. ~ oate~fAccidp, .,~ t{);.. 190 7 Time cf' ~ Location, ~ / ~ Mine No. 7 Entry No. If not injured in Mine, ate where, 7 J ' ,,, / ~~ 1 t:Z. n? . 43 Room No. 9 ,,a . , , ~ ~. Name of Mine Supt. Name of Mine Forman, Age of Person m1ured, ~ ,:2.,, ~ Sin;le • What Family, if any, - - - - - - - - - - - -- How Jong in employ, of Oo. ,~ 1/ ~ : 0011/ition <JI Life;fJ); Oircumstances, Name and addr~ss of nearest liuing Relatiue, i f ~ ) (; . /[)~ ~-1"'~ , 1 Was he an effictent man, ~~J . £,, W~s heJ e'J)pcratc,. e_ (/ Where and in whose charge left, t>V_;jf~ / ~ ~a Name of Physician called, if any, r.J y ~ ,,,..,,.,3/~ Name and P. 0. Adress of Witnesses. NatureandextentofAcoident, .4~ ~ ~ ~ ~ -t5t ~ ~ cv~· Oause, ( ., I.' (Signature) Date 1 tJ �Sl'A'l'f.;MH.N'ff:i OF WITNESSES. �9~1 rJIB UNION PACIFIC COAL CO. -- - - Mine No. ....................................... . RfiroRT OF PERSONAL INJURY. 8up'ts No ................................... . ya,n, of Person injured, o,,upation, ~ ---~ f 0 'A. oate of Accidjj1t~ / ~ "- ~ 1 Looation, /l,(n,-4' ' ff 110t injured in f,f inr, s ate wher ~~ ~ 190 7 Time .2,' u ~ ~Mine No. / Entry No ..2-&x ~Room No. {/ IA};. ~ /51~ /{:)~ Name of Mine Supt. Aga of Person injured, , .3.-b What Family, if any, Condition of Life or Oircumstances, How tong in employ, of Oo., ,,t, ~ Name and address of nearest living Relative, was he an efficient man, ~ Was he temperate, Where and in whose charge left, ~~ ~~. Name of Physioian oafled, if any, ~~ /4)~ ~+ .,a ~. /f • Name and P. O. Adress of Witnesses. ~,~. Nature and extent of Accident, _ ,,,fJ~ ~ _....?--vv ~ ~~ ~ ~ Oause, (Signature) Date 7 A1~. ~~vie Title, ~4~ �Form 1.23. ~ UNION' PACIFIC COAL CO. fftP fl6l'0 R _ T OF pBRSONAL INJURY. Mine No. ........................................ 8up'ts No.................................... ,,,9.cr.t- • cf~ , person injured, N11meo, occupatio11, ?tr-v- / oate of Accidet'Y} ~.J~".,,,..A-c-, Locatioll, /'C,v-r/l ~~(£;__:_~ - {!- / •niured in Mine, state where, l/110t l'J ~ . ~ Name of Mine Supt. ./~ Age of Person injured, ~ t¢. ~~ • 1~0 7 Time / / -a': ~ . Mine No. 7 ~ Entry No. - - Room No. ;!:f</ · /al~ Name of Mine f Jrman, -{;. 'G. MttffierJ-6£ Single .-2- d IVhat family, if any, How /ong in employ, of Co., )':?;7 Name and address of nearest liuing Relatiue, ~/ " 7 was he an efficient man, .Jf~ Where and in whose charge left, - /7 -- ~~ Was he temperate, ~ ~ • ~ ~~ Name and P. O. Adress of Witnesses •. Nature and extent of Accident, Cause, (Signature) 1 h ConditiolJ,..Df Life or Cirou,w;tances, /£) ~ ( 'd.h-~,,_/) f/lrt:4'}"' ~ Name of Physician called, if any, Date ~~~ /ll ~ ifip.t • / J �"'""E"'T"'S OF WITNESSES. ST.A.TEL'.l ~ n .L ~c;..,r-rr· P,{A/4r #~ ~~ • �... rN[ON PACIFIC COAL CO. r11E l • ptPOR _ 95 1' Form 123. __ _ Mine No......................................... T OF PERSONAL INJURY. I 8up'ts No..................................... ~~ .1 Person injured, 11ame o,. /~c,,,e,,;;;t:;;. /2'~ -. occupat1on,. • ~ 790J oateofAct!)• 1/ Location, ~ ~'f<./ Mine No. If not i,ifured m Mme, s a,.t. e where, ~~ ~1 • ~~ • Time J,,' -'/v /?~7 J Entry No.4 .V~r~ Room No. / C ~re , ~ Name of Mine Forman, 6.,.eof Mine Supt, Age of Person m1ured, ./1/. ~..:-v--~ Marrie P 8/, g!e What Family, if any, / ~ ~~ How long in employ, of 0o.' cf ~ f~ °!)ndition of life or Circumstances, Name and addr:ss of nearest liuing Relatiue, c:7 , ,.4,,-v~ ~ ,°;P?2~ ( /(r,,-~_,4f..,.,,d ) ~ , r ~ ~ , was he an efficient man, ~ Was he tempt}l(ji,e, ~ f ~_,.-' 7,,,..-:, .<f<7 Where and in whose charge left, 4 ,..., ?"?-rl - -i:.---z.-/ ~vve----r,;:-v? r:ftl' ,;:r~tf.-~ 1 1/ameof Physician called, if any, _.,......, tJ ~ ;:;. c. - -, ,. .- tJ'7,,✓. - - ? ~ f j ,-,,-1--~ . k- . ,...,...-· flame and P. 0. Adress of Witnesses. Nature and extent of Accident, Date 1 I 1 ~ I � https://haylibrary.cvlcollections.org/files/original/83251734b57cbdd8016db789a7800078.pdf 962d27d85468703f0c050f84494a21a4 PDF Text Text STATEMENTS OF WITNESSES. �L Form 123. rut UNION PACIFIC COAL co. Mine No . ........................................ . i_ RIS por,>T OF PERSONAL INJURY. \ 8up'ts No ................................... .. I::, e 0 .; Person injured, Nam 'J occupation, oate of AccidJn!J Location, •~ If not injured in Min e, tJ,7 7 • /'- _; ~ ,. ~./tA.-,, 7.?.2 - . ~ u.,,,e. ( f = e--~ 790 7 J t,,7/'~ :ft/_;::;-v Mine No. Time ~ <12 Ckz;/.r ti?~. / IP' Entry No. ~ Room No. cf"7 ate where? . • /~~ Name of Mine Forman, Q,,,,.&-/ / /2- ~ ~ Age of Person rn1ured, . ¥ c::, / • Marrie~ ;::,uv 0 ~~4 ~ What Family, if any, ~ ~ t_;',! How tong in employ, of Co., / .,,,...ij ~ ,JJondition of Life or (]ir~umstances :[, . Name and address of nearest living RelcJiue, -{£, ~~~~/) ~~ Name of Mine Supt. ~r &; ~:. Was he an efficient man, 't; Where and in whose charge_ left, •,f Name of Physician ca//ed, if any, V e~ J/ ~ ~ . ~ Name and• P. O. Adress o1 ",.t vvl nesses. ~ V tf!_.. ./Was he tempera~ , e. ~/~ A~ ~~c ,:r-r-/"~ ~~ •/ ~ , j r /ft/ /~ i.-:::: _ -~~✓ ~~~ ~ ~~ tr~ Nature and extent of Accident, ; Cause, ,,;< \"' '-. -- C.:.• • •·l,H)J.. 011. , ,r/ I f - • ~_ �STATEMENTS OF \VITNESSES. t?cn:/1 ~~~/') /4lr r,or-1'-'/ - ~ /%/4 4 ~v-~~ r ,::,-,, 0(7 1 _✓vV&vtc,d-- vl.--c-". ~~ /~~ ,4. ~/--u a£ -,,.-~ I Y 7 • ~ --?n.-. • ~fl~ a:,e .H,n/4,cX . ~ _z,· ,:µ VC/C _ __ _ _ •r:?7 . ~~ ~ ,,,-~_,,.~"L-::.- ~__,,____.__.r • ~ ~ • ~ / ~ /4 ~7~ ~~ ~.H~d~~ ~ . ~C,, . ~ =/ ' I I .I �rrrE UNI Form 123. ON PACIFIC COAL CO. -· Mine No. ...................................... .. r J?TWO R T OF PERSONAL INJURY. iJ 8up'ts No ................................... .. I ~~ ~ }7/o..,./~~.A--...4 .; Person injured, Name 0'I -::;:r✓ --::_::::._ ,,, ' : occupation, //J ,,fl ~ oateof AccidJJjt, -~1.1/4~~-~.rrr /;; J _ 790 7 Time t/•011 " / VV--r4.A7". Mme No. / [oca , ~ ---r • • •ritired in Mine, s te where, 1 If 110 t II~ ~~ /4}~ 'k Name of Mine Supt. Age of Person injured, :;;1.. 7 What Family, if any, How long in employ, of Oo.' " and address of nearest !iuing Relatiue, l,ame "· Was he an efficient man, Where and in whose charge left, Name of Physician called, if any, ·c2:~ {7? ~ / . li-l'lt· n, 7 1·!J ,.,g, ~ Room No. Name of Mine Forman, ,(/? ~ Married or Single V - Condition of Life or (]ircumstances, ff e-a.-,. £ Was he temperate, . ~ P-~ /Q/~~ ~,z} p > - ~ )Id Jf Name and p, o. Adress of Witnesses. Nature and extent of Accident, Cause, (Signature) 7 J}_tl::TZ/__.6<...../ - Jt ~ - K~L~ a~ �STATEMENTS OF \VITNESSES. I I I �J?lff'O R C hQ : ~..J,o Form 123. PACIFIC COAL CO. ~ uNT ON ffJP I Mine No. ____ 1' OF PERSONAL INJURY. __ .. 8up'ts No. ................. .................. :1 , ~ ...dk~ - person injured, Name o1. '-:P' /'7? .?c--"~ occupa t,011, /a A t, ~ / 0 ~ 190 7 .J oate o1 Acc~·d -. Location, t:/"~ ~ Min e No. i t . iiured in Min e, state wher6, • ;Y / I Jf 110 II~ Time / Entry No . q /7 Room No. ~ Name of Mine Forman, ~{/, _t~,, - ~. Name of Mine Supt. /;;)~ • • Single ~~ Age of Person injured, 2----r; What Family, if any, How Jong in employ, of. (Jo.' oZ ~ µ:ondition of life or 0ircumstances, d address of nearest living Ffefatiue, ~, 3/. . /r--& • /// . Name a/I ~IA;-v✓ , ~~ t / ~ 1 was he an efficient man, ~ Was he temperate, vf,,£. ~ / Where and in whose charge left, ./(y~ ~ q ~----// Name of Physician called, if any, _...,..,.f C?-~ )Y-7 ~ --Y~t//----0 • .J:/ • Name and p, o. Adress of Witnesses. Nature and extent of Accident, f . 4~ r12Vv~ ~ ~ ./~& ~ ~ 'f ~ . Cause, (Signature) 'I I II ! ',,1 I �~ p ACIFIC COAL CO. Forni 123. ,r '(J 'NIOJ.." r,1~ • NI:•f'ON t,·amoof . i.) 0 Mine No. ......................................._. -- - - --··- · INJURY. r oFPE•DSONAL _I( 8up'ts No .......... ........................... personi11jttred, A l ~ ~ ~ £1 #~~ , ,~ . ~ . tJ~ ✓-7 ~ 7901'7 Time M ( [ J ~ -e::T·~/. of A ~ ~;,_.i,.,,o ~ - Mi11e No. / P Entry No. J Room No. .:b7 Location,_ d. Mine, s;«;;,,e;:, ""A' / occupation, _ /tf?// 1JQ.t• lj not i1lj ure ,n . ~ ~/i)/4c4-- mine Supt. wtl ·/'] · R' Nameo1 . . d ~/ of Person m1ure , .. Age ·1 if any, ., ) What fanl/ y, 1 ,.; Co 3~ O fnginempoy,OJ '' • ffoW nd ddress of nearest lioing Relatwe, /:?/.A~/~ Name of Mine Forman, 10 • • B.ing I e • <.!/"'77 ....-. /_L ~~ Namehaan aefficrnnt • man, was e ,-F d in whose charge lei t, Where an • /lame o;,F Physician called, if any, /lame an d P• O• CondiUon of Life or Circumstances, /.7 . . n J G'17 1/7. ~R") ~wv/rAL_ 1/U~, 1 . ';::{ c& ~ ~ ____--,v ,,,-1/ ./- a,<.a, Jf ~ /4 Was he . ~ tfl./J... . t7{/__;, ~ tem~1era~, ,,p "A/7~ ~ O'-l:.--.~ /, v -'if .,/1 ~ -y✓.:::J h . p7 I/ ~ cz.--~ / . Adress of Witnesses. Nature and extent of Accident, Cause, r (Signature) Date Title, �STATEMENTS OF ·w rTNESSES. ! I , �Form 123, ~ oNJON p ACIFIC COAL CO. rllP __ _ Mine 1 O< J! No . ....................................... . 1' OF PENSONA l., INJURY. Nl:f10N 8up'ts No.................................... . ,; person injured, 11ame o1 occupation, oate of Ac Location, t t:;:·;l;;., , ~ .,,;,,red in Mi ,, state If 110 t I~ game of Mine Supt. .A~ ~ ::>--(p Mine No . ~ / ~~ ge O'J,; Person in1ured, Time 7907 7 Room No. Name of Mine Forman, ~.._j M A ~/f),,;--: _ • , , s·111g Ie ,:;r ~ , , ~ What Family, if any, , / L-How long in employ, of Oo.' .,L./ 'j:.-- ~~ Coy<iition o Lif~ or Cira}:)nstanoes, Name and address of nearest living Relative, _,,,&-c.-r_,,,,~_.,,,,..,,..,#'7 k /~ {&~) was he an efficient man, Where and in whose charge left, Name of Physician called, if any, fl fA/- t:f: r ~~L 01: .: . ~ . g ~ as he temperate, [,,<2/ • ~~. ~~ . ~ ~2"Y ~ . Name and P. 0. Adress of Witnesses. Nature and extent of Aaaide11t, _ t i { ) ~ ~ ~~ ~ ~ ~ ~ff· tJ (Signature)~~Date C-7-la •lJ:l-·UII. Title, J ~~ YT i �sTATEMEN'fS OF ·w1TNESSES. �rI-IB - r · 'I ~J .t l Mine No ...................·.................... . Form 123. trNION PACIFIC COAL CO. -- R1' OF PERSONAL INJURY. REPO \ Sup'ts No............ ........................ , person injured, f!ameo,1 occupation, ~ ~ ~~ ~fl _ 7 ot.. ~tr"'!- / ~ oate~JAcc~tf Location, %iJI. •niured in Mine, state wher , ff 110 t l 'l / ~v&,,---r 790/ Mine No. ~ 7 Time ?---0~ ~ Name of !fine Supt. 4t_,,('')'e'] -, Person 117Jured, . /tJ ~ Entry No. ~>7?. Room No. ~ . .-w/ { - . ~*~~m~ What family, if any, /"l / L .:2- !:~_..........{1, ~. ...n.-F L,:1' a· , How long in employ, of Oo.' ~ . . . -~ Oonditi:'?Y-}J Life or Ui_!au,pnstg,ffle~, / ' Name and addr:ss of nearest humg Relatwe, t /_l/'.:1,,-f" . _ ( / ~ ! ' ( ~ ~u,;,- ) 0 Ap~ Was he an efjiaient man, ere and in whose charge left, .Jf ~ ./- /- w/l ,,/V/._.b-U/'t,, ~ /A / tl:--c./,d - ~ Wa~he tem erate, -J/fa&--e-,, • --<: / • ,p7?,1 ,,L _ / ( .. £..-?l/" __.e,.-(".,A'A ,~~.-,v ~0 __,,f5j~ p Nameof Physiaian ea/led, if any, - { • \._,..L---0 • e,.,-" (!_,, '-' 7 /jJ ~ - ~ • U Name and P. O. Adress of Witnesses. JI I I • I Cause, ~/? (Signature) F 1 c:..,.1•·0'J--on 7 ~ ~. -~~ �STATEMENTS OF ·wrTNESSES. l COPY t.TO}Ll.1 \;.· • Lr. c.c,i Gcncrc.l.., Attorney Cheyenr~o, 11 ':/0 o r. .:.._rr il l G., 19080 Iiore-,; it]-. accident r 0 i")Ort in th_e cas e o ·. Tony r:.a jshovich, injurco. ir• -n ociA Sr,r inn•s ·1-r:o. 8 mi L, . ne' January 20., 1908 o Ur,on the f acts as state. I see n o the Co,c.r.w·, - •11.,• lio.bilitY on the :ear • . 7.. our s very trul:.v f • I L John r.' . Lacey t 0 t' ' �Form 123. gE uNro'N PACIFIC COAL CO. 1' - - Mine No .........................•................ g&PO RT 8up'ts No ....... .............................. OF PERSONAL INJURY. •' ,Z .. ; person 1111ured, l .-~ / ~? •• // • / ~e.,/'uBo-~c/./{_,, ~. . Name 0'J /"'1 .,,, 71'?, ocaupation, /: r, /V uA.--, ate of Accifi,cy:;t, £.. f f _ / / _:,,•, ~~/c,r,{/ 190? Time /~,' 4.er-o-4'- c?/-Y/ D I f;,- 4✓&/~ ?:: -i.--? ~ ~u- . . • , • v • .4ff () Location, v 1. ~·-Z: . ?/ ' - ' . _/ f _, ,, ~ -: Mme No. ;::7 Entry No./ llZc,, al/~oom No. If not injured m Mme, sta_te he,e, (/ •• 4 a -~--/4,·; e~~~ ~ ,./ ~ ~ v Name of Mine ~u~t. ,, a,(/,I· Age of Person 1111ured, '!( .:. - What Family, if any, How Jong in employ, of Co., ~ .» £ ·· ✓- / Name of Mine FJrman, ~:I--. ,::--.&-,-kk--t--d• ,:::2,o /tZc.c, ) ·/Vku-..rcierl.::eF Single ~ J /4 ~~ ._Condit[Pn of Life or Circumstances, Name and address of nearest living Refa.tiue, Where and in whose charge left, JP//4,~r. r/,-tf;AZ/ J_/ . ,,,- I -#11-o-o//~Z:Z, Nameof Physician called, if any, . . (/ was he an efficient man, _.q:,--=-~ fl. E;-"C-/ • Was he temperate ' a ,, ·} ., 4~ . Name and P. O. Adress of Witnesses. Nature and extent of Accident, 0ause, ~~~ ~ 0/, ) ,o ~ JIii ~r~ q (Signature) Date C-7-ta.03•. 0ll, �sTATEl\IEN'fS OF \VITNESSES. I ,1 I I �I - - - - - - - - - - -~..... ..I'f) AT ca_ - - ~- :-, - .JFf~o'.::rm ~ 1~;•2a=-. - ~ ~ - - - - - - - - - - - ~ -- - - --~ --""- - - - · .. (' . ·.: ..... -- : • .·· . ~ \ La.cey ? General ..:-. tto r uo;y ._To }:.;11 .. • Ch eyerrne , \~ ~·o . i:. r,r il 16 , 1908 o Asst. Gon' 1 I:e).·. U. :i:' . Co r..l Co., I! j inJv.1·cd in _·,oc1 t~prlnc;;s 7 o. 9 min e , Febrvar;;,, 3 , 1 908 . �i UNION r.?lt1'0RT OF PERSO ~ ,. vame of Person injur rpccupation, ~ ( •!Jate of Acci ' , --~~ocation, l t 'f not injured i11 Mine, z'.'.,·. ~ Name of Mine Supt. f:•• fv- . n fP • • .,..; '""' , 8 ,1 t , : ' - .: n P Y. THE U1U ON PACIF IC COAL GOJIU?.AMYo Mr . G• Lo Black, s urrn r in t ,.1ndent., Ro c}{ Spr i n tss. Dear Si r : -I encl os •J herew ith al l pape r s i n the case of Willi8'.I!'1 .?: . Pree c e who was killed 'in Mo. 9 Mine, Febru~xy 3rd, 1 9 Cl8 , We have ae;>teed to pay the Widow, Mre , 1\ldn a Pree c e, $ 100,00 i n sat t lP.ment of any and all claims wh ich s'1o ma,y e n t ertai n a r,ai nst thi s Gompany on ac c ount of the injury and death o:::' s,, id Will i Wl :rs. Pree c e, aud "t tached to the enclosed r,apers is ,. a an i nstr um9n t di· awn up by J udge r,acey to be sir:;ned by Mrs , F,dna Preec e in t he prese ne e of t wo witnesses . P lease ha"e this ,,aper properly s iesned i n dupl ic a t e b y Mr a . P re,>ce and cluly wi tn,, ssP.<i, and l'lake up release vouchA>" in f ay or of Mrs. P ree c e a nd pay he r $100,00 and n;,1H the voucher to the Loc a l Treasure r as c a oh . Send me a dup lic. a t e of ~he voucher a.Y!d copy of the gene ral re l ~a se wi th the return of thA e ncl ose d payer'S o Yours truly , A. R. Bradbut yo ... Attach •• o Date �1'l" PACIFIC COAL co. Form 1'!3. Mine No . ... --- 'TSRSONAL INTUR J tY. ·········-·-···········- Sup'ts No ...... ........ ··················-· -C -() P- Y- o '--"' anrl executed thi s 24th da.Y of Dec o A• .D o THt S I~S~RID_.lflill~T., }-/Ia•~,..,_ ~-' - 1_,, wi dmv of thP- l a t e Willi ar:l. E . Pree ce, of 1 ., b y and be ·twe ea EDJ\TA. PR1rwci~ • • d •:J county of Swaet iat P-r and ~t at e of Wyoming, p ar t y of the first. part 0 . J , . .a AiIT, a co rporat i on organ iz ed and exist i ng ~nd the UNION P .-\CIFIC r,oA.T r.01 [P .. • • • a "e of Wyomin5 , party of the se c ond l) art , un der t h a laws of the St t \VI '.r lIBS SETH ; That i n conside ration of the s um of one Hundred (1 00,00) Dollars tc her in hand ::.>aid b y the saiO. ])a rty of the ue c ond ~,art, t he r e ceipt whereof i s h ereby c onfe s s e d and acknowl edged, the said party of the f i rlit !'ar t h ereby rGleases and d i s charges the said par t y of the se cond ])ar t of and from any and alJ. liability of eve ry kind whatsoever in re l ation to t h e i njuries r eceived by the said dece dent Vl il lialfi 1', l'ree c e , ,-hile in the em• p l o y of ~'1.A s a. i ,l , ,a rt.y of l;h~ se cond 1,art an d wh i ch. in j ur :\As resulted i n hiB deatho And i n cons i derat i on as aforesaid t;1~ s"-id party of tha first part aa na r ebY sc,lls, as s igns , t,ransf ere and sets over to the s a i d party of t he se c ond part any and a ll da.mal!es, moneys, ,ra.luables and proper t y of every 0 kin ci. what so ever wh ich may at any time h rAafter inure to or i n favor of the said 1/ar tY of the f i rst part on a cc ount of any claims or damages tha t may at any time be collect ed or recov P,re d of or fr om the said party of t h e secon d part in re l a t ion to t he said inj u rie s an d deat h of the sai d Wil}.iam E. Pre e ctN•eo W! TlIB:!3S WJf.W_,Rl'lOF the said party of the first p a rt has hereunto ~et he ,r h a nd an •l seal the day and date first abov a writ ten, (Siened) Edna PrP-ece S igne d , Seal ed and Del i vere d i n pre s enc<3 of (Signe d ) R. ~liaS Geo• A. MurPhY• (Se al) �1 (()~J Form 1!!3. tHB UNION PACIFIC COAL CO. Mine No . ....................................... . REPORT OF PERSONAL INJURY. Sup'ts No ................................... . Name of Person i11juredy,~;,,, 7 = & ~e-~ occupation, --.;,.._,-?c.a-- r c::- ::? ~ - / • ' Date of Acci/fip(, .,#r2f ~ /?~ ~ v ----- 190 ,tr Time cf' ~~ ~Pf_ Location, ~ F/ ~ ·" I r ~ · .. . Mine No. Entry No . Ro~~n_Jo· - If not injured in Min e, state wh~e, ,, 7 • 7 / ./.:.----Yt-G- &✓~~·-r- t;?--v(/ t:t:vL/7 ~#;.h~ a .. 9 Name of Mine Supt. ~~ •s:.:;~• • ,e. d{;-,/'.c_Y.?'Z<.-c-~.r Name of z Age of Person injured, /4-f~. /~~ / Marrieds. g· g 'a What Family, if any, P"v'/ ~ .3 ~ &-----c.How long in employ, of Go., c>J ~ ~,-:: .. ~iyon of Li:fJ:5PK Oircumsyrn,,c_ep /7) Name and address of nearest l1ff'uin Relative, ~ l ( / ~ k?L v::? ~ l?i-,5~ -/ ,n; . t ,. ./7 _,., -7 Was he an e1J'c1en man, --v--~. Was he te13p1!JP-t~, ~ Where and in whose charge left, ~~ /1 4::1/~~ 6-/-y ~,· -,,,tf"~ Name of Physlciancalled,ifany, -,/ ~ ~~ & ~ ~ v-. - 'T'f • 1 Nature and extent of Accident, ~ ~ ~~ ·, ~ ,, • ~, /?-~ (7.,-£..--- ~ ~ -k?c - --- _.,,v--______,-,,r---;;r c?-< ✓//P.t. .«- -' 1-./t--v.,C.,' L-V-,' T_ 5!3/~- ..,.,-------,,,- ./~./.VZ,.,4C._..,/(/ (Signature) 7 , ~e--a-- ~ 7 ~ # A ~ ~'AU,/~E # C-7-15-03-•0ll, /$ £ ~ ~~~~:c-~ /1-u; Date A,///""~~ ~v✓ ~ ~~L ~ --h~ ~~ aoovalvR~ A. ~ Z /tl--- M.#7: : -~~.::::-- - 7 ~r~~ :i I I Name and P. 0. Adress of Witnesses. r I I 1 ed Cause, f!/,i _, • ��Office o_ J ohn ~-., . L.. ce~• (', 1;:10ral 1· ttorncy I::r . .i.·•• .,.. Br: c1. hury 0 As s t . C-en ' 1 I:er. TJ . r- . Coal Co., De31• Sir:- He Pci . ith accid Gn t r -~art i i: the cas e o f' Goore;o Lerovich , injm•ed in 1To. G mine, Roc 1>:: Spri11e;s, ;'/;yoming , ,Tamiar;;" 22 , 190 8 . Upon the f a cts a s stated I see no liabilit;y on t h e pa rt of t h e company. Yom·s ver~r t rul ~r , ...,. , I (Signature) Date C-7•\a-OJ.. GB, �1 1 :11 ·-n ' ~ --,., U ·-- J TflE uNION__:~~~I_FIC COAL CO. - -~ .... ..t-1... Mine No.····-'································-·· RE PONT OF PERSONAL INJURY. 8up'ts No. ····························--······ 4 -C ~ ,-F Person injured, Nam e 0'J ""(/- •c✓.--?-? . // ~/ .../4----?-~ occupat,on, ¼,~ / "' 7-t--:tP/ oate of AcciJJJJ1l: , ~ ~ :,, - &-_ •.2- /// 190 f t-£,t,r;/1~/j ~ 7 Q l/(/--y.,..e,,• nn • ,,,. -r mll1e No. loc ation, If not injured in Mine, state where, Time / ~ cJZe~ t::Z ~ ~~ c7 Entry No.= '7 ""'2-' ,,, -~,<--"-Room No. ,-,,- rJI P Name of Mine FJrman, Name of Mine Supt. . . / tt~/6J~A:: ,::2,;z: ? ¥ Age 0'J-F Person 1111ured, _.-...__ - - -- · · -=airrrrzr i:r s·mg Ie What Fam~ly, if any, :// /.,.-; ~ . How long 111 employ, of Oo.' ::;?eY7'?'/ ~ • OO)Jdition of l),f-y or Oircum t ces, Name and addr~ss of nearest living Relatiu~, j/[,,r-v~:2{[;.,,.~ Was he an efficrent man, ~ Was he ~Jl,,;e:ie Where and in whose charge left, f/ . Name of Physician called, if any, __;~ Y ~ e2-, • ,1f J. ~ 7 ~~~/ Name and P. O. Adress of Witnesses. ~1/J. t., Nature and extent of Accident, /1 /I( 't / • I i aause, (Signature) ·Date C-1-1 ••00.. ou. ~~da:c Title, ~~,:,.,«/, ��.. ,." ,r PACIFIC COAL CO . . Form 12:1, .' OPY Offir. , of Joh1 •••• :.:-.ac e~r C:-cncral .L tt orne? C:heyc1111e, • yo., Apr . 16, 1 908 . r.:r. ! . . I . I3ratUmry , Asst. Gen'l :.:gr. U. r . Coal Co., Dear· Bir:He rc.7i th a ccident r i') Ort in tho c:1s o f Pola Se l ev is, i n j nred in Eo. '7 mine, Rocle S:p1~incs, Januar;y 21, 1908. Upon the facb as sta ted I see no liabili t ;y on th e part of t he Cornpnny. Yours t r -..: J. y , �JI\ {J.NION PACIFIC COAL CO •. rr • Form 12:1. _ _____ >T OF PERSONAL INJURY. RJ;PO [,\ Sup'ts No.-- ------------ ----·- -·-···········- Name and P. O. Adress of Witnesses. Nature and extent of Accident, aause, Date �•• I ' I I! I I I ! I , OF WITNESSES. STATEMENfS • �PACIFIC COAL co. Form 123. UOPY - t ,JI • ~-ffico o f Jo; ...1i i"i. Lu ce ~· ~ C:: 0 , ::.0 1•" 1 ,'ctt crne - 'I I I { J.- · ~' - . ,,.,... ,1"ot11• t.J, ir _J,.c... ...,_ !Ier c.,: i th <,c c idcut r 01, ort i n t h c ca s o o i' ; :i ke ( oc1, is bj1 1· , <J Ci, On th e f a cts as sta ted .I sec no l i e:.b U it· r on t he :fc.'..lrt o f t h e Com1~any o r Yo1u·s v ery trul y ~ I / I I (Signature) I �. . rfl6 vNrQN_ p,.~~I~~c COAL co. Form 123, .. I ,. , ·, Mine No. .. ........... ................... ........ ''-.c 1 0'(; 1 )T OF PERSONAL IN URY 9HPOl\ J • 8up'ts No. ·· ·· ·· ··· ········ ······ ······· -····· # ~ ~ - #" • ~-Z. • ~ occupation, ue~~ oateoJAa~id ~• / e 3~ ~/ • / #ld/t/c-,/l 790 (Jtr . ' pt[_ · Location,i . . , ~ ·Mine No. / , t ; iured m Mme, s te wher , ; person injured, flame 0" ~ ~~ • Tune • J/?:t:1//. f 6 -,._-;,~! Entry No/ta,.c,- !24,1:R oom No.,Ole,tv'~ /:/ .,L- l11 110 11 NameofMiaeSupt.~~ ~ Age of Person injured, _ J...;./ £41. What Family, if a11y, ,!a./4 ' ? ~ ' Z ~- ~ a ~; ~. . N . • - -. -~me of Mtne Form~n, Mame ~ How long in employ, of~. - ::i- (t?Jl c,,,,.,,..,~ - _,,, was he an efficient man, ~.,a/. Where and in whose oharge left, -3/ ~ Name of Physician called, if any, 0~on d'JJP1} •• of Lii • • ~ • ~ ~ , (/£ $~ • 'Vas '1}~-e~f}er. te, ~ ,,,.&<:Z-- • ':!/ p--,,-7,-z.,,,,. - -f /~~ ~ t7 ·yf,/. z...-. e ____..,.-'j ~/ ~~:J:,,~ e or Otraumstanoes, e,.,,-u/ Name and address of nearest liuing Re atiue, • • //~ Name and P. O. Adress of Witnesses. Cause, (Signature) ~/ ~ c...---; - - �Form 123. oNTON PACIFIC COAL CO. r116 ;:/·1'0RT JL (Gj r? .----- Mine No . ........................................ oF PBRSONAL INJURY. 8up'ts No.·····························-····· COPY THE 1l1;I01~ PAC I FI C R.f._ILROJ,D COiiPAIE Office o :i. John \'' . L cey 9 Gen era l _,_·~ttor n ey ,Lo;y-ennc , \':, o . A: ,r il l G, 1908 . ) ~ I J l. . .l, • J ) Ch eyerme, \'/~/ Oo Deo.i• Sir: He r E.Y:ith ..,ccident r er;ort i n tJ c c,-Nse of 0 idnc;y- .'ilto , Jdll cc1 in Rock Spring s J:fo. 10 !.'.line, Se1~tcr-.ber 1 , 1907 . D11011 t he f .s.cts a r; sta tctl t here is possib l e J.i a bility . I '-'.d vis e settl er:1ent \'"i t h n.drni n i str-=,tor if' it can be d one on reas onab l e t e1'1ns o John i'/ . La.ceu. 7 (Signature) 7 �f 116 Form 123. N PACIFIC COAL CO. rrNI O -- - -- -· , F' pBRSONAL INJURY. Nl:roN1 0 8up'ts No ................................... . 4~7 ~~ ,f person injured, Name OJ / occupatio11,. ~ / , ; a /7A ,I Accz1d t, • / / /j, oatCOJ ~ t:; "' t1/V~ atiOII, / . Loe t itifured 111. Mine, state w ere, ~ , Time # (Jl ~ c:P~ /t:::J Entry No . .3 ~~r Room No. 7901 Mine No. £, f/110 /~~~ .!J.c:;, Mine Supt. flame O1 • d ,f Person i11Jure ' Age OJ . - hat family, if any, Name of Mine Forman, ~A'~;:# ~ / 7 ( _ _ _ ~a-le ge ~- L / ~ ,/ .. . in employ, of Oo., u.--~ 4 ~~~Gond1t1~11 Life ou;a·oumstanoes, How longd address of nearest humg •• • ~ ·>r J L /9 I , ✓/'~ . ~, , ~ ~ &d. Name an o _.c;",,r7t: • ,, ~ __,.,IIJ ~ --, was he 011 efficient man, .:::I:~~ ~ ~ Was he rem~erata, tZ4-,,--. aAJ ~ ~ lld ;11 whose charge left, -:.ctJ.,,:.,,ef~ ~/u,,, ~ .,,<-,--vC.4---ua- ~ ~ , Where a . /-:-/ ~ ~ _../' ,£Physician called, if a n y , ~ ~ ,,_.e/ /#'/. W ~ flame OJ o AdressofWitnesses. Name an dp• • / ~ ~ / / 4 £ 1 , , , ~ p d ~r k ,,(J~~/d _.7 • ~ / ~~ · ,, /,?~7 : 1 Nature and extent of Aooident, I Cause, (Signature) Dllte 1 - • �MEN··rs OF WITNESSES. STATEl·.L' . I ( \ ( , I ~! I J �Form 123. r fl6 v~roN PACIFIC COAL co. r---..l1l • OF PENSONA L Mine No ... IN] CJRY. ······ ······· ············-·· 8.i1n~ s fi.Q .... ······· ·:.:.·· ··················· Offi c e of J o1 n ·;: . L8.c ey nc;1cr2..l A.tt orncy Choyc11110 : Gy o. , li.r;ril 1 '7, 1908. 1·.r . . A. 1~. Bradlrn.i·y, HcrC'."l i th a ccident · ro~~ort i n t , e c as e of :Loui s Pr evcdel, i n,jurcc1 i n 4f9 mi n e Rocle Spri ne;s , il.r,ri l 3rcl , 1908 . U.i?on t h0 facts c.r. sto.tcd I se c • o li: b ilHJ on ·~he i-:~rt cf J ohn •.•. , ;;>,CO;·T o \ \ \ \ \ (Signature) 1 �,T rr16 tJ~I O... Form 123, PACIFIC COAL co. - - --- Mine No. •••••••••• ••• •••••••• ••················· oF pJSRSONA L INJURY. J?1£f10Nf 8up'ts No.................................. . .t person injured, t1ameo1 0 c11patio11, e3 #q g:t,ofAcif'J'-t,4' @~ 1ocatJOII, . ~ / ~ . Mi 11:~:': / ' " ' • • ·ured in M/111', If not IIU '-! - ~ _j/ .Z,'..:¼ ~ _ J /?~ En try No ..f; J ~ Room No. / ~ I I' . Name ofMi11e Forman, ~ , ? i i , P , J f ~ ,.,,JMineSupt• .,,~ ,;{i)~ 1 .,person ul}ured, ,;,OC7 --::J,f ~ _-:ft!J • r \o· Ageo1 .,,, / .orng1e . IYhat family, if any, ,,-,, .. Hwlong in employ, of Oo., ~ Oo11d1t1011 of Life or OiratZ::.m tanaes 1 0 d address of nearest living Relative, . § ~ ~ ~ ' #' O //ame an . ~...o -h--~ l'lrv/11 ~I was he an effio1ent man, /1 (/_::...,.,- • A / ~ - _....;, Was he temperate, g?p-.,,,,e, • / i d in whose charge left, ~t?--<7;;,f Where an 7 / /lame of p11ysioian oalled, if any, . ...J-fj'-~Y {Jc{~ ~ 7 . 0. h /lame and p, o. Adress of Witnesses. /lature and extent of Aooident, Cause, V l I/ 7 ; � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Union Pacific Collection Description An account of the resource This collection is made possible in part by a generous grant from Wyoming Humanities. All materials are the property of Union Pacific Coal Company, on long-term loan at Western Wyoming Community College. For usage inquiries, contact the <a href="https://www.uprrmuseum.org">Union Pacific Museum</a> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Record of Personal Injury Rights Information about rights held in and over the resource CC BY-NC-ND Date Created Date of creation of the resource. 1907 Subject The topic of the resource Collection of records regarding injuries and accidents within Rock Springs mines. Description An account of the resource 14" x 8.5" book with black cover and red spine. Some pages are faded may be hard to read. Type The nature or genre of the resource Text Creator An entity primarily responsible for making the resource The Union Pacific Coal Co. Identifier An unambiguous reference to the resource within a given context 1-0019 Publisher An entity responsible for making the resource available The Union Pacific Coal Co.