Laserfiche WebLink
DEPOSIT AGREEMENT• J a <br /> DEPOSITOR <br /> Gary Boyce Airst !�utk <br /> D/B/A Rancho Rosado e National <br /> Assigned To St. Of Co / MLRB <br /> 111 ItIninosa <br /> • <br /> Post Office Box 1139 <br /> • Alamosa,Colorado 81101 <br /> ADDRESS (719)589-6611 <br /> "BANK" <br /> 117425 Co. Rd. 66T <br /> Moffat, CO 81143 <br /> Account Number Number of I Opening Opening Deposit <br /> Signatures Rqd. Date Amount CIF# Office/Officer <br /> 7899 1 04/22/94 $25,000.00 0001 / JR <br /> SIGNATURES- In consideration of Bank's agreement to open this account, and other value received by each of the undersigned, the undersigned Depositor <br /> whether one or more) agrees to the terms stated on this form (including the reverse) and acknowledges receipt of this Deposit A�reement and (if checked) <br /> Schedule of Fees and Charges x TIN instructions Funds Availability Disclosure x Bank rules and regulations Ix ! any separate account <br /> agreement Truth-In-Savings Disclosure . In the event of any conflict or inconsistency between the terms of any separately receipted document and this <br /> Agreement,the terms of the separately receipted document shall govern and control. Depositor also authorizes Bank to check credit and employment history <br /> should it deem necessary. The terms and conditions of all receipted documents,together with all terms and conditions stated on the reverse hereof, <br /> are incorp• - e. herein • eference. <br /> 1. X , _ 5. X <br /> Gar :o � O er <br /> `a <br /> 2. X �� ` 6 X <br /> ST.- OF CO / RB <br /> Di rector v <br /> 3. X 7. X <br /> 4. X 8. X <br /> OPENED BY TELEPHONE NO. BUSINESS INFORMATION <br /> SKD (719) 256-4613 STATE OF ORGANIZATION: <br /> AUTHORIZATION DATE: <br /> TYPE OF BUSINESS: Mine <br /> DEPOSIT SOURCE BANKING REFERENCE: <br /> Cneck(s) - Local FACSIMILE SIGNATURES Y/N: No <br /> CHECK LOCAL VERIFICATION: <br /> ACCOUNT TYPE PRIMARY PURPOSE: TO HAVE A CD. <br /> CD - 12 MONTH CD OVER 25,000 MAILING ADDRESS(IF DIFFERENT THAN ABOVE) <br /> - f <br /> OWNERSHIP q <br /> Sole Proprietorship (DBA) I " <br /> SPECIAL INSTRUCTIONS: lad tfG <br /> PDPA #010004005101 t,IIj <br /> X TAXPAYER I.D.NUMBER-My correct taxpayer identification number(TIN)is: BACKUP WITHHOLDING-I am not subject to backup withholding either because I <br /> 521605697 have not been notified that I am subject to withholding as a result of a failure to report <br /> all interest or dividends,or the Internal Revenue Service has notified me that I am no <br /> Fl (Gary Boyce) longer subject to backup withholding. <br /> APPLIED FOR TAXPAYER I.D. NUMBER-A taxpayer identification number has <br /> not been issued to me,and I mailed or delivered an application to receive a taxpayer LJ NONRESIDENT ALIENS - I am not a United States person, or if I am an <br /> identification number to the appropriate Internal Revenue Service Center or Social individual,I am neither a citizen nor a resident of the United States. <br /> Security Administration Office (or I intend to mail or deliver an application in the near <br /> future). I understand that if I do not provide a taxpayer identification number to the SIGNATURE: By signing below I certify under penalties of perjury the statements <br /> payor within 60 days, the payor is required to withhold 31 percent of all reportable checked on this form. <br /> payments ttiereafter made to me until I provide a number. <br /> EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue X <br /> Service regulations. BACKUP WITHHOLDING CERTIFICATIONS <br /> PFUN107© FormAtion Technologies,Inc.(5/27/93) (800)937-3799 <br />