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-::... iii iiiiiiiiniiiiii ^^^^^ 999 _ __ ivesfr~nt Deposit Agreement `~ iMO/tM'ESr BANKS (Book Entry) - • ^^^^^ _ :^.^^ ~~'lal3 ,.. ,. .: , ... I .i.l,~. ~... .,: 1..:..~i, t.'i:::.~,.~~~:. t.. ~:~f:: L::S ::: V./~ ~I:a'h 4:~ Fd.IT'f..l~...i;:F:::PILaAI i•I(.1 ~,~,, r. i b a~ ~I~, ~ ~. r~ :i. is •,. . . .. i :I. I'1 't, ~.:., .. .. .... '1'i'~.•!:i l.i. r..::ll ~: ~.~ (~~ I 'I~^~ I~I.. 111.i~ . i'I.:.~ i1.:' _:... jai-.'~i.l" ,.. ....:,<`. .:I .i. ,.:l~i,:.;<.:.~i, I:. i.?.n-1 `Di'ia'li>,Lp.) ... ,... i""I Released and made payable only:" John, Terry and Ward Nichols / r raw.ti ~~~t- y'chael B. Long, irecto ~ ., ~ ~ Division of Minerals and G~ology „'~ Office of Mined Land Reclamation State of Colorado The Internal Revenue Service (IRS) requires for interest paying accounts the following: the owner whose social security or taxpayer identification number appears above certifies, under penalty of perjury, that (1) the owner's social security or taxpayer identification number is correct, or the issuance of a social security number or a taxpayer identification number has been applied for, (2) the owner has received a copy of the instructions contained in IRS Form W-9 (incorporated herein by reference),. and (check one); ® that such owner is not subject to backup income tax withholding either because such owner is exempt or because no notice has been given that backup withholding is required due to lailure to report all interest or dividends, or because the Internal Revenue Service has given notice that backup withholding is no longer required; or ^ that such owner is subject to backup withholding Authorized Signatures: STATE OF COLORADO NICHOLS GRAVEL PIT , MINED LAND\RECLAMATION DIVISION Signature o! Dep sitor Signature o! Depositor '~ geceived ey, ~" . ~ , ~'21~-~ Signature o7 Depositor ~ Authonzed Age ~ The Terms on the Reverse Side are Part of this Agreement Thank you for investing your funds at Norwest Banks a9a (Rev. a911