2005-11-30_REVISION - M1981276

• Permit No: M1981276
• IBM Index Class Name: Revision
• Doc Date: 11/30/2005
• Doc Name: SO Approval
• From: DMG
• To: Wes Herzog Trucking
• Type & Sequence: SO2
• Media Type: D
• Archive: No

ANK. OF ~LORADO
250 W. VICTORY WAY
CRAIG, QJ 81625
[phone]
OWNERSHIP OF ACCOUNT -CONSUMER (Select One and Initiall:
^ Single-Party Account ^ Trust-SaDerata Agreement-
^ Multiple-Patty Account
^ other
RIGHTS AT DEATH ISelect One And Initiall:
^ Single-Party Account
^ Multiple-Party Account With Right of Survivorship
^ Multiple-Party Account Without Right of Survivorship
^ Single-Party Account With Pay On Death
^ Multiple-Party Account With Right of Survivorship
and Pa On Death
PAY-ON-D EPICIARIEe: To Add PaY-Oo-Death eeneticiaries Name One ar More:
~e ~se an~, ma~g ayable only to:
~~s e og ruc n~
RotYald`~ y, Dire for
Division of Minerals a d Geology
Office of Mined Land Reclamation
State of Colorado
OWNERSHIP OF ACCOUNT -BUSINESS PURPOSE
SOLE PROPRIETORSHIP ^ PARTNERSHIP
^ CORPORATION: ^ FOR PROFIT ^ NOT FOR PROFIT
^_
BUSINESS: TRUCKING OJMPANY
COUN'rV & STATE
OF ORGANIZATION:
AUTHORIZATION DATED:
DATE OPENED Nov• 15, 2002 BY SB
INITIAL DEPOSIT 5 34, 500.00
^ CASH CHECK ^
HOME TELEPHONE d
BUSINESS PHONE 7
DRIVER'S LICENSE X
E-MAII.
EMPLOYER
MOTHER'S MAIDEN NAME
Name ~lnd address of someone who will always know your location:
BACKUP WITHHOLDING CERTIFICATIONS
TIN; _521-74-7793
TNXPAYER I.D. NUMBER -The Taxpayer Identification Number
shown above ITINI is my correct taxpayer identification number.
^ BACKUP WITHHOLDING - I am not subject to backup
withholding either because I have not been notified that I am
subject to backup withholding as a result of a failure to report all
interest or dividends, or [he Internal Revenue Service has notified
me that 1 am no longer subject to backup withholding.
^ EXEMPT RECIPIENTS - I am an exempt recipient under the
Internal Revenue Service Regulations.
SIGNATURE: I eerdry under penaldea of perjury the statements checked in this
section and drat I am a U.S. person fncluding a U.S. resident alianl.
X / _Q L
IDatel

Fes; ®1992 Bankers sYSmma, Inc., 9t. Cloud, MN Form MP9C-LAZ-CO 11/19/2000
AccouNT 800009334
NUMBER
ACCOUNT OWNER(S) NAME & ADDRESS
Wes' 1~1~' TRjTQtIN('
ASSIGL~ TO SPATE OF ~UJR2.1D0 MLRB
]?DPA #010004005101
D31ENVERO 03' '~ 215 RECEIVED
NOV 2 0 2002
Division of Minerals and
NEW ^ EXISTING
TYPE OF ^ CHECKING ^ SAVINGS
ACCOUNT ^ MONEV MARKET ~ CERTIFICATE OF DEPOSIT
^ NOW ^
This is your (check onel: 48 + Months Business CD
;~ Permanent ^ Temporary account agreement.
Number of signatures required for withdrawal II(~~y 1
FACSIMILE SIGNATURE(SI ALLOWED? ^ VES iiP NO
Lx J
SIGNATUREIS) -The undersigned agree to the terms stated on every
page of this form and acknowledge receipt of a completed copy. The
undersigned further authorize the financial institution to verify credit
and employment history and/or have a credh reporting agency
prepare a credk report on the undersigned, as individuals. The
undersigned also acknowledge the receipt of a copy and agree to the
terms of the following disclosurelsl:
^ Deposit Account ^ Funds Availability ^ Privacy
^ Electronic Funds Transfer ^ Truth in Savings
111: X
~~ J
ASSIQ~D TO STATE OF CWLORADO MLRB
I.D. # D.O.B. ~(.~G~~//
121: ~X G/pr..G(-~,~C~ !X/ ~/
RONALD W. CATTANY J
I.DD,~rector Division afD,~~nerals and Geology
(31: [X / \
I.D. N D.O.B.
141: [X ~
I.D. # D.O.B.
AGENCY~RWER OF ATTORNEY) DESIGNATION IODtionall: To Add
Agan I nation To Accnl~nt.,Nart~ One.or 1Aore Agents:
(Select One antl Initiall:
^ Agency Designation Survives Disaaility or Incapacity of Parties
^ Agency Designation Tarminataz an Disahilky or Incepachy of Parties
See Addendum for Contract Terms . rpe9e 1 ar zi