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NOTE: Supply longitude and latitude or UTM coordinates if lands have not been surveyed or <br />as supplemental information to this NO1. GPS measurements will be acceptable for this <br />purpose: <br />Lat: <br />827073E, 4213166N, UTM NAD 83 (See attached maps) <br />X: <br />Long: Y: <br />6. LAND OWNERSHIP: <br />❑- Private <br />State1-1 <br />❑� Public Domain (BLM) <br />State Sovereign Lands <br />National Forest (USFS) <br />❑ Other (please describe) <br />If prospecting is located on BLM or USFS land the remaining section must be <br />completed, otherwise go to section ll Maps & Drawings <br />7. PROSPECTING ON BUREAU OF LAND MANAGEMENT (BLM) LAND AND U.S. FOREST <br />SERVICE (USFS) LAND <br />The Division and the BLM/USFS have entered into cooperative agreements that eliminate <br />the need for a prospector to post a financial warranty with each agency and allow them <br />to coordinate the review of the NOI in order to minimize administrative processing time <br />and effort. <br />A. CLAIMANT: <br />Name <br />Address <br />City, State, Zip <br />LKA International, Inc. <br />3724 47th Street Ct NW <br />Gig Harbor WA 98335 <br />253 ) 514-6661 <br />Telephone <br />Fax L <br />Form 2— Public File Page 3 of 14 <br />