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, �. _ • <br />.._ .,.�-� <br />C� <br />APPUCAYION BY OFFICIAI CUSTODIAN <br />FOR ASSIGNMENT OF <br />PUBUC DEPOSIT PROTECTION ACT (PDPA) NUMBER <br />FOR PUBLIC FUNDS DEPOSITED IN BANKS <br />Complete a separate appt'�cation for each 'pubGc un�', defu�ed below, or �her entitty mentioned in �11-10.5- <br />103(9)(b). C.R.S.. br which you are an official custod'ran of pubGc fu�ds deposited in a bank Please r�efer b the <br />� ed instructions for inforrnati�on on oompleting the appllcatio�. The definition of an'o�ficial custodian" appears <br />m�11-10.5-103(9). C.12 S.� a oopy of which is attac�ed to the instrudions. As discussed further in the instrucbions. <br />�ifnre this appl'�cation. or errors in the oompletion of this appGcation� may rewlt in the loss of <br />protections otherwise appl'�cabte � publ'ic funds and/or o�iCial custod'ans. ' <br />� Please note that this application does p�t apply t� W�ds deposited in a savings and loan institution. <br />�_�_. - .� _ _ __ <br />._ .��, <br />A check /n the amo of i10.00, payatile to �he T State of Colorado ; must accompany �ach <br />. comp/eted app/ication.�fter receipt and processing of tfie compteted application, a PDPA number wID be <br />. assigned and the official austodian will be notified of the number. Official custodia�s must notify thei� <br />. bankeKs) in writing of thei� o�iginal PDPA numbers. Retum the completed applicatjon and check to: <br />. Public Deposit P�+oteetion Program <br />Division of Banki�g <br />State af Colorado <br />• 1560 Broadvray. Suite 1175 <br />� Denver. CO 80202 <br />PLEASE TYPE OR PRINT ALL iNFORMATION. <br />. A. NAME OF PUBUC UNIT OR OTHER ENTITY: � e �c ,I r.� �1 a��� � oc� e 2 Q: u�2 G� iP e u�� Sn.c , <br />' B. IDENTIFY THE TYPE OF PUBUC UNtT OR OTHER ENTITY NAMED IN A, ABOVE <br />��� 8.1 Is the entitty name in A a"publ'ic uniY"� whic:h� for the purposes of this application. inGudes onty the Sta�e of <br />� Colorado. or a county. mun�cipaC�ty, or political subd'nrision (defined below) ther�eof? <br />� . ._ <br />� Yes No� <br />"The term 'potitical subdivision' �dudes drainage. imgation. navigation, improvemerrt. tevee, san'dary, school <br />or power distrids. bridge or poR authorities. and other special districLs created by state statute or oompac.�ts <br />between the states. It also indudes any subdivision of...[the State. oounty or mun�cipafiry] or any prinapal <br />department of ...[tfie State. oou�ty, or municipality]: <br />(1) The creation of which subdivision o� departrnent has been expressly autt�or¢ed by the law of such <br />pubtic uni� <br />(2) To which some functions of govemment have been delegated by such law. and <br />(3) Which is empowered to exercise exGusive control over funds for its exclusive use " <br />If no, move to B.2. <br />If yes, check the one category of the following which most specfically describes the type of pubC�c unit you <br />named and then move to C(if you check one of these categories, �io not check any categories in B2�: <br />