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LPPD000392
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LPPD000392
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Last modified
8/15/2011 9:37:08 AM
Creation date
3/26/2007 10:35:28 PM
Metadata
Fields
Template:
Loan Projects
Contract/PO #
C150015
Contractor Name
Highland Ditch Company
Contract Type
Loan
Water District
5
County
Boulder
Bill Number
HB 98-1189
Loan Projects - Doc Type
Contract Documents
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<br />FIRST NATIONAL BANK <br />OF LONGNONT <br />PO~OX 1159 <br />LONGMON~ CO 80502 <br /> <br />OWNERSHIP OF ACCOUNT - CONSUMER ISelect One and Initial): <br />o Single-Party Account 0 Trust-Separate Agreement_ <br />o Multiple-Party Account <br />o Other <br /> <br />RIGHTS AT DEATH ISelect One And Initial): <br />o Single-Party Account <br />o Multiple-Party Account With Right of Survivorship <br />o Multiple-Party Account Without Right of Survivorship <br />o Single-Party Account With Pay On Death <br />o Multiple-Party Account With Right of Survivorship <br />and Pay On Death <br />PAY-ON-DEATH BENEFICIARIES: To Add PaY-all-Death Beneficiaries Name One or More: <br /> <br /> <br />OWNERSHIP OF ACCOUNT - BUSINESS PU <br />o SOLE PROPRIETORSHIP 0 PARTNERSHIP <br />xIX] CORPORATION: 0 FOR PROFIT IXkNOT FOR P <br />o <br />BUSINESS: DITCH CO <br />g~~~l,~~I~l~;bEN: WELD CO <br />AUTHORIZATION DATED: SEPTEMBER 11 , 2000 <br /> <br />DATE OPENED 09/11/2000 BY <br />INITIAL DEPOSIT $ 6e; QQe. eEl <br />o CASH [XOO:;HECK 0 <br />HOME TELEPHONE # <br />BUSINESS PHONE # <br />DRIVER'S LICENSE # <br />EMPLOYER <br />MOTHER'S MAJOEN NAME <br /> <br />FLS <br />- <br />C-~OO <br /> <br />Name and address of someone who will always know your location: _ <br /> <br />BACKUP WITHHOLDING CERTIFICATIONS <br />TIN: 84 - 0226700 <br /> <br />IXkTAXPAYER I.D. NUMBER - The Taxpayer Identification Number <br />shown above (TIN) is my correct taxpayer identification number. <br /> <br />IXk BACKUP WITHHOLDING - I am not subject to backup <br />withholding either because I have not been notified that I am <br />subject to backup withholding as a result of a failure to report all <br />interest or dividends, or the Internal Revenue Service has notified <br />me that I am no longer subject to backup withholding. <br /> <br />o EXEMPT RECIPIENTS - I ~an exempt recipient under the <br />Internal Revenue Service Regula ions. <br /> <br />SIGNATURE: I certi u er p n Ities of perjury the statements <br />check . 's sec' n <br /> <br />v' 9-IZ-CJO <br /> <br />(Date) <br /> <br /> <br />F8lffib2 SJ-nkers Systems, Inc" St. Cloud, MN Form MPSC-LAZ-CO 3/16/99 <br /> <br />ACCOUNT 749710 <br />NUMBER <br /> <br />ACCOUNT OWNER(SI NAME & ADDRESS <br /> <br />HIGHLAND DITCH CO <br />A COLORADO NON-PROFIT CORP <br />FBO COLO WATER CONSV BOARD <br />4309 HWY 66 #3 <br />LONGMONT CO 80504-9629 <br /> <br />MONEY MARKET SVGS BUSINESS <br /> <br />TYPE OF <br />ACCOUNT <br /> <br />IXkNEW <br />o CHECKING <br />IXkMONEY MARKET <br />o NOW <br /> <br />o EXISTING <br />o SAVINGS <br />o CERTIFICATE OF DEPOSIT <br />o <br /> <br />This is your Icheck one): <br />IXkPermanent 0 Temporary account agreement. <br /> <br />Number of signatures required for withdrawal <br />FACSIMILE SIGNATURE(S) AllOWED? 0 YES <br /> <br />2 <br />IXkNO <br /> <br />[X <br /> <br />] <br /> <br />SIGNATUREIS) - THE UNDERSIGNED AGREEIS) TO THE TERMS <br />STATED ON PAGES 1 AND 2 OF THIS FORM. AND <br />ACKNOWLEDGEIS) RECEIPT OF A COMPLETED COPY ON TODA Y'S <br />DATE. THE UNDERSIGNED ALSO ACKNOWLEDGEIS) RECEIPT OF A <br />COPY OF AND AGREEIS) TO THE TERMS OF THE FOLLOWING <br />DISCLOSUREIS): <br /> <br />IXkDeposit Account Disclosure 5axFunds Availability Disclosure <br /> <br />IXkElectronic Funds TranSfer Disclosur 0 TIS Disclosure <br /> <br />o <br /> <br />I'" ~d"W1 <br />TOM REYNOLDS, <br />I.D.# <br /> <br /> <br />] <br /> <br />D.O.B. ~- 'S/~ if'> <br /> <br />(2)'Iu~~ 2~ ] <br /> <br /> ROBERT SCHLAGEL, <br /> I.D.# D.O.B. <br />(3): <br /> D.O.8. <br />(4): [X <br /> <br /> <br />] <br /> <br />] <br /> <br />I.D. # D.O.B. <br /> <br />AGENCY (POWER OF ATTORNEY) DESIGNATION (Optional): To Add <br />Agency Designation To Account, Name One or More Agents: <br /> <br />(Select One and Initial): <br /> <br /> <br />o Agency Oesignation Survives Disability or Incapacity of Parties <br /> <br /> <br />o Agency Designation Terminates on Disability or Incapacity of Parties <br /> <br />(page 1 of 2) <br />
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