PERMFILE68969

• Permit No: M1992051
• IBM Index Class Name: Permit File
• Doc Date: 12/10/1991
• From: CARESTIA TRUCKING CO
• To: MLRD
• Media Type: D
• Archive: No

THIS CER7IFIfJITE
EVIDENCES A
DEPOSIT IN THE
NAME(S) OF:
IN TAE AMOVNr
Mined LaND Reclamation Hoard, State of Colorado
1313 SheLTnan cenificale Number
Denver, Co 80203

Account Number
Date DeCeitlhPl"~ ti 19 _SI-_.
DOLLARS S z,saana
Il will (fir50 mature on M_r`P~r ~r ,19 ~3_.-.
'~=ga( -t The minimum balance is S L, 7UU . UU
f-')0'~~I INTEREST: Your deposit will earn interest al the rate of 5.366 96 per year to the first maturity dare.Wecalculala interest using the-~~~' 366
~)_~a
~~r. ~ days per year method. We will compound interest (accrue inletes~,on inte[es0
~ ; ^' We will pay interest Mail check t~Iarterly to Carestia Trucking Co 420 N McCandless
t }S%; The interest rate we will pay on automatic renewals of this certificate will be the same rate we alter on o e r dale which
=~;F~ ~ have the same term. minimum balance, and other characteristics as Ihis original cenificale. You may call us on or shortly before the maturity date and
I_ r we can tell you what the interest rare will be for the next renewal term.
i YOUR DEPOSIT W1LI NOT EARN INTEREST AFTER THE MATURITY DATE VNDER'LH[S CERTIFICATE (UNLESS IT IS RENEWED).
~.l 'p- ~~ 1 RENEWALS: ~}f if checked. we wW aulomalicagy renew this certificate on each succeeding FREMON7 NATIONAL BANx OF CANON CITY
. ,-..
f r~..t ~ maturity date. Each renewal term wW be the same as the original tens, beginning on 532 MAIN 57., BIN 31
i ; ~ ~ ~~ i the maturity dale. We wig not automatically renew this certificate (q if you sell us not CANON CITY, COLORADO 81212
r to do so. in wrung. on or before the treat matudty date, m (2) if you present this MEMBER FDIC
~ '. -(!;.~ i certificate to us for payment (or other disposiuoN on or within 10 calendar days otter /
~ "~?`., the maturity dale J it hasya tern of more than 31 days, and one calendar day i! it has ~i /~~ _- i) /~
a term oC seven to 3l da BY C Grf~ ~.
.ul SINGLE MA7UR17Y: ^ 1t checked. we will not automatically renew Ihis certificate. It will AS513tant V1Ce President
"sl Wit- mature once on the maturity date.
awNERSIDP -PERSONAL (Select one e~ SdBe1)
^ Single-Party Account
^ Multiple-Party Account
^ Tmst Agreement Dated:
^ Other 6
RIGA75 ON DEA]'A (Sleet one ead Inttlep
^ Single-Pang Account
i ^ Multiple~Party Account with
~ Right of Survivorship
^ Multiple-Party Account
without Survivorship
^ Single~Party Account with
Pay-on-Death
^ Multiple-Party Account with
Survivorship and Pay-on-Death
The NUMBER OP ENDORSEMENTS needed for
withdrawal or arty other purpose is'. ENE
AGENCY (POWER OF ATTORNEY)
nsslGNArlox (OWmaeq
io Add Agency Designation To Account, Name
One Or Mor¢ Agents:
(Select One And initial):
^ Agency Designation Survives Disabgity or
Incapacity of Ponies
^ Agency Designation TemUnates on Disabikty
BPDDTlCIRWRS OP
NON-PERSONAL ACCOUNTS:
is a: ^ Partnership [Corporation
Authonzation dated
L 1963 fiANKEnS SL'6TEMS. INC., ST CLOUD, MN v631n COMB. LPSCCO nl 6'2190

SOCIAL SECURITY OR EMPLOYER'S I.D.
NUMBER - A correct taxpayer idenlificalion number
is required (or almost every type o! account. A cer
tification of this number is also required and is con-
tained on the fiat copy of this certificate.
DiNG • A certification that you
are not subject to backup withholding is necessary
for almost all accounts (exwpt (or persons who are
exempt altogether). This certification is contained
on the first copy of this form. Failure to provide this
certification when required will cause us to withhold
2096 of the interest earned (for payment to the IRS).
Providing a false certification can result in sedous
federal penalties.
ENDORSEMPN75: SIQo only vhm Qoo regaset
sdUrdrewel.
RFJID 07I~It SIDE POR ADDITIONAL TERMS