2018-12-12_REVISION - P2018010

• Permit No: P2018010
• IBM Index Class Name: REVISION
• Doc Date: 12/12/2018
• Doc Name Note: Request to Modify Permit
• From: LKA International
• To: DRMS
• Type & Sequence: MD1
• Email Name: TC1
• Email Name: MAC
• Email Name: THM
• Media Type: D
• Archive: No

I.the undersigned,being the NOI holder or the person authorized to sign on behalf of the NOI
holder,declare that the information given in this NOI form is true and correct.
SIGNATURES MUST BE IN BLUE INK
/ r
Signed and dated this 29 th day of November 2018f
(date) (month)
Signature of NOI holder or person authorized to sign:
Name (typed or printed): Kye Abrahun
Title/Position: President
M:\min\oss\slb\MineraisForms\ProspectForm2
30 Aug 2017
Form 2—Public File Page 14 of 14