C150048 Paid in Full Contract

• Contract/PO #: C150048
• Contractor Name: Plumb and Dailey Ditch Company
• Contract Type: Loan
• Loan Projects - Doc Type: Contract Documents

•
FIRST NATIONAL BANK ACCOUNT NUMBER 31463
OF LONGMONT j
P.O. BOX 1159
LONGMONT CO 80502 ACCOUNT OWNER(S)NAME&ADDRESS
PLUMB AND DAILEY DITCH COMPANY
OWNERSHIP OF ACCOUNT-CONSUMER(Select One and Initial): FBO COLO WATER CONSV BOARD
0 Single-Party Account 0 Trust-Separate Agreement 9595 NELSON RD BOX C
❑ Multiple-Party Account LONGMONT CO 80501-6359
O Other
RIGHTS AT DEATH(Select One And Initial):
❑ Single-Party Account BUSINESS CERT OF DE EIOLSIT
❑ Multiple-Party Account With Right of Survivorship
❑ Multiple-Party Account Without Right of Survivorship j i
❑ Single-Party Account With Pay On Death EkNEW 0 EXIS1ING
❑ Multiple-Party Account With Right of Survivorship TYPE OF 0 CHECKING 0 SAVINGS
and EAT OB Death ACCOUNT ❑ MONEY MARKET a CERT FICATE OF DEPOSIT
PAY-ON-DEATH BENEFICIARIES:To Add Pay-On-Death Beneficiaries Name One or More:
❑ NOW ❑
This is your(check one):
{Permanent 0 Temporary .account agreement.
1
Number of signatures required for u,ithdrBwal 1
FACSIMILE SIGNATURE(S)ALLOWED? ;❑ YES EkNO
1 I
, ]I
OWNERSHIP OF ACCOUNT-BUSINESS PURPOSE X 1
❑ SOLE PROPRIETORSHIP 0 PARTNERSHIP '
XlilCORPORATION: ❑ FOR PROFIT OT FOR PROFIT SIGNATURE(S) - THE UNDERSIGNEID AGREE(S) TO THE TERMS
STATED ON PAGES 1 1 AND '2 OF THIS FORM, AND
❑ ACKNOWLEDGE(S) RECEIPT pF A �COMPLETED COPY ON TODAY'S
BUSINESS: DITCH COMPANY DATE. THE UNDERSIGNED ALSO4CKNOWLE,)GE(S) RECEIPT OF A
COUNTY&STATE COPY OF AND AGREE(S) O T iE TERMS OF THE FOLLOWING
OF ORGANIZATION: WELD COUNTY COLORADO DISCLOSURE(S):
AUTHORIZATION DATED: OCTOBER 4 , 2000 {Deposit Account Disclo$ure 0 :unds Availability Disclosure
0 Electronic Funds Trans*DisOldsura 0 TIS Disclosure
DATE OPENED 10/04/2000 BY DJ 0
INITIAL DEPOSIT$ 3,022.41
IA
7
❑ CASH L HECK a LOC U. S S. BANK r J
HOME TELEPHONE# (1): LX
11?7,°
BUSINESS PHONE# [phone] LES WILLIAMS
DRIVER'S LICENSE# I.D. # 522-58 ' . 0.0.B. 10/14/44
EMPLOYER
MOTHER'S MAIDEN NAME BEE .
w�.�. ' i
(2):
Name and address of someone who will always know your location: _ X
I
ARTICLES OF INC ON FILE MARGARET E HILL,
OFAC CLEAR I.D. # 524-38-5058 D.o.B., 10/01/31
BACKUP WITHHOLDING CERTIFICATIONS (3): r
TIN: 84-0293625 LX
TAXPAYER I.D.NUMBER-The Taxpayer Identification Number liAll j)
shown above (TIN) is my correct taxpayer identification number. I.D. #
a BACKUP WITHHOLDING - I am not subject to backup
withholding either because I have not been notified that I am 1
subject to backup withholding as a result of a failure to report all (4): IN J
interest or dividends, or the Internal Revenue Service has notified 1ii4E1X
me that I am no longer subject to backup withholding.
O EXEMPT RECIPIENTS - I am an exempt recipient under the I.D. # 1 . D.O.B.
Internal Revenue Service Regulations. AGENCY (POWER OF ATTOF#NEY)DESIGNATION (Optional):To Add
SIGNATURE: I certify under penalties of perjury the statements Agency Designation To AccoUnt, Narhe One or More Agents:
checked in this section.
I i
X (Select One and Initial): 1
PLUMB AND DAILEY DITCH COMPPi1VY-e) 0 Agency Designation Survives Disability'or Incapacity of Parties
ppRR
FBO COLO WATER CONSV BOARD 0 Agency Designation Terminates ion Disability oy Incapacity of Parties _
Fe4192 Bilkers Systems,Inc.,St.Cloud,MN Form MPSC-LAZ-CO 3/16/99 I (page 1 of 2)
I I !