2017-09-06_REVISION - P2016019

• Permit No: P2016019
• IBM Index Class Name: Revision
• Doc Date: 9/6/2017
• Doc Name: NOI Form 2 Public File
• From: Viscount Colorado Holdings, LTD
• To: DRMS
• Type & Sequence: MD1
• Email Name: TC1
• Email Name: WHE
• Media Type: D
• Archive: No

SIGNATURES MUST BE IN BLUE INK
Signed and dated this day of r'r-.a7C�� . F.f, 2 0 i 7
(date) '(month) (year)
Signature of MOI holder or person authorized to sip:�/�
f
Name (typed or printed):
Title/Position;
M:\mln\oss\slb\NlnemIsFornu\ProqmctForini
30 Aug 2017
Form I — DRMS Use and Confidential File Page 14 of 14