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ertificate of Deposit Receipt <br />B,4NK ONE, 4405965 <br />Member ERIC ~ VET <br />ACCOUNT TITLE/ADDRESS <br />Mined Land Reclamation Board <br />P.O. Box 624 <br />Ouray ~ 81427 <br />REC~I AccouNr # 0920034405965 <br />APR ~ 7 1995 ISSUE DATE <br />2127195 <br />Division of minerals ~ ueolo9Y MATURRY DATE 8/27/g7 <br />TERM 30 Months <br />INTEREST RATE 5.35°~ <br />ACCOUNT PURPOSE <br />Business <br />TYPE OF OWNERSHIP <br />Public Funds <br />DEPOSR AMOUNT <br />2500.00 <br />ANNUAL PERCENTAGE YIELD 5, 50% <br />INTEREST COMPOUNDING Dally <br />PAYMENT FREQUENCY 12 MO$ <br />INTEREST DISPOSITION [mil t~1eCk <br />TYPE OF DEPOSIT jnVe9tCBent <br /> <br />TAXPAYER ID # 84_0768338 <br />TIME DEPOSITS ARE NONNEGOTIABLE AND NONTRANSFERABLE PDPA 010004005101 <br />This nonnegotiable receipt is provided solely for the convenience of the customer. The deposit referred to hereon is set forth in the records of the Bank and is subject ro the rules <br />and regulations of the Bank applicable to this account. All deposit items accepted are subject to rules aM regulations pertaining to deposit Vansactions. <br />ISSUED BY <br />"~ '. <br />Bank One Montrose Main <br />0035 2!27/95 <br />Merlinda Barrientos BANK EPRESENTATIVE DATE <br />303-249-1111 <br />AcknowMdgement-By sgning bebw, I acknowledge receipt of the Terms of Deposit that appear on the reverse side of this receipt, and agree to be bound by the agreements and terms <br />contained therein. 1 also agree that the Bank may share information about me or my account to other hank antl non-bank affilates of the Bank as well as to other thirtl parties, inclWing <br />credit arM check reporting agencies. I further acknowledge receiving notice of any early withdrawal penalties that apply to this deDOSit. <br />Certification-I certify under penalty of perjury that (p the Taxpayer Identification Number given above is correct and (2) I am not subject to backup withholding because: (a) I am exempt <br />from backup withholding, or (b) I have rwt been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or <br />dividends, or (c) the IRS has ratified me that I am no brxrer subject to backup withhoklirg. (VOU must cross out item 2 above it you have been notified by the IRS that you are currently <br />subject to backup withtwkting because of underreporting interest or dividends on your tax return.! <br />i)x Reissued/Bank Gomnersion <br />OWNER'S SIGNATURE <br />2) X <br />3) X <br />dNIJER'S SIGNATURE <br />4) X <br />OWNER'S SIGNATURE <br />DATE OF BIRTH <br />IDENTIFICATION <br />DATE TAXPAYER ID # <br />2/27/95 84-0768338 <br />PASSWORD <br />Reortler: COq rs (6/94) <br />N79321 0 1993 BANG ONE CORPORATION <br />