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' Agency ID RDA <br /> I -- SAN I f I )( 5 7/0 <br /> STATE OF COLORADO CUlCt— JAN ILL/AN. X 346 2.. <br /> AUTHORIZATION AGREEMENT <br /> FOR AUTOMATIC DEPOSITS (ACH CREDITS) <br /> I (we) her etta at4tflorizitl D arr ent of 1Y AT u R1 r< R�5(�112n , State of Colorado, <br /> hereinafte l TA E,to initiate credit entries,and if necessary,debit entries and adjustments for any credit entries in error to <br /> our bank account indicated below and the Bank named below,hereinafter called DEPOSITORY,to credit and/or debit the same to <br /> such account.rEp;,,, Jr <br /> NATUR= , ROES <br /> APPLICATION (f;oayment Type) .• , '1'! i <br /> ENTITY NAME Rio Grande Water Conservation District/Well Rehabilitation Fund <br /> FEDERAL E.I.N. NUMBER 8 4 _ 0 6 0 8 4 5 7 <br /> ADDRESS: 10900 U.S. Highway 160 East <br /> BUILDING , <br /> \. <br /> it <br /> STREET r <br /> CITY,STATE,ZIP <br /> Alamosa, CO 81101 <br /> DEPOSITORY NAME Vectra Bank Colorado ti�� , , <br /> BRANCH Alamosa Branch e' -- <br /> ADDRESS: P.O. Box 1139 % �. <br /> - '' <br /> BUILDING k O �p bE,A. /r <br /> STREET s`0 -`S-Q.S �� rr`/ ✓P <br /> '0‘x dii CITY,STATE.ZIP eb a�O���`�` iV �,y:.., <br /> „ V �Vf j <br /> DEPOSITORY TRANSIT NUS' � 5�� <br /> 7*()5• �w <br /> i o1 '��_ / 001 // <br /> DEPOSITORY AxCCq' %5�G,,1g $9x-epe o1 ci_D, <br /> 6 1 1 i <br /> CHECKING I/-!' �P� Q\90 'GO �jj• ��,/ <br /> (PleaseQ� P�t�` <br /> G. t <br /> ■ o ,T, •T /r 0 <br /> Q <br /> • ' '/ tten notification from the ENTITY of its <br /> /r , . j ,opportunity to act on it. It is the responsibility <br /> 40 <br /> ✓�. o°.1- ��•• ants. <br /> s y <br /> n` t`OO•1P SS O01o''v.- �\ _... <br /> P <br /> (719) 589-6301 <br /> {L mac° b Phone No. <br /> • ' , / /://1/ ,464-7 <br /> '' 4+Ya.,a cure <br /> - - < , 000 <br /> }� <br /> V „ r <br /> 4' EeQ° 0 Title f <br /> �j c. <br /> _ <br /> .+uthorized Signature li — <br /> �,� -. ' Title Secretary/Treasurer <br /> 0b '/DISTRIBUTION: WHITE•Accounts 8 Control CANARY-Agency PINK Entity <br /> Y • N <br />