Laserfiche WebLink
Operator(If Other than Permittee): <br /> Permittee Representative: .Jodi Schreiber <br /> Certified Mail# -load Oki-1 o boo SS34, t.saa <br /> In accordance with Rule 4.17.1(2)the Operator shall include the names,addresses and phone numbers of all <br /> owners of record to the affected land. Please attach additional sheets for this information if required. <br /> Name Address Phone Number <br /> K I CT L L C 9 West 57th Street, New York, NY 10019 <br /> In accordance with Rule 4.17.1(4), if requesting a partial acreage release the Operator or their agent MUST sign that <br /> they have complied with the following statement: "All applicable portions of the Reclamation Plan requirements <br /> have been satisfied in accordance with these Rules and all applicable requirements under the Act." <br /> X ,9.49/t42.0.- <br /> 11/14/2025 <br /> Signature of Permittee,ttcc, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.17.1(3) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> MmeralsRelcascR Elms!Form 2OScp2017 <br /> Page 2 of 2 <br />