REV103767

• Permit No: M1978091UG
• IBM Index Class Name: Revision
• Doc Date: 7/1/1994
• Doc Name: GOLDEN WONDER MINE PN M-78-091UG RECEIPT OF 110‎(2)‎ RECLAMATION PERMIT AMENDMENT APPLICATION AM-002
• From: DMG
• To: LAKE CITY MINES LKA INTL
• Type & Sequence: AM2
• Media Type: D
• Archive: No

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9. Correspondence Information:
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)
Individual's Name: Kye A. Abraham, President
Company Name: LKA International, Inc.
Street: 3724 47th Street Ct. NW
City: Gig Harbor
State: WA Ztp Code: 99335
Area Code: (206> Telephone: [phone]
PERMITTING CONTACT (1f different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Zip Code:
Telephone:
INSPECTION CONTACT
Individual's Name: Same as above
Company Name:
Street:
City:
State:
Area Code: Telephone:
CC: SATE OR FEDERAL LANDOWNER (if any)
Agency:
Street:
City:
State:
Area Code: Telephone:
CC: STATE OR FEDERAL LANDOWNER (1f anv>
Agency:
Street:
City:
State:
Area Code: Telephone:
Zip Code:
Z1p Code:
11p Code: