ENFORCE31683

• Permit No: M1982129
• IBM Index Class Name: Enforcement
• Doc Date: 9/24/1997
• Doc Name: NO PROBLEM FORM
• Media Type: D
• Archive: No

9/zJ/97 TUE 15: J2 FAS 17197J8E~047
______________________________________________________ DOLLARS

PayaDleYNewrlersignep'sDardrmg dnrn,roseppeppyra.dr,dmoro man me. to euneraranYOl said Depositors dr Me swvxers orsurvrvdr, upy!presenrarion entlsum~lder
dl otu drurrara propvy endorsed, on e7yNdry dare.
0 SINOLEYATURITY: Presem thlgcendlfbra DrpmpUy at maturity for payment as it!s not automarrcanyrenewaDlDand no interestwm ac[ruearler me ma7unrydate mown
f}:AUTOYATIG RFJYEWLL: 7his[lrlihwle matures on maturity Gale slatetlapdve, put wnl aummannlly De ronewDd ter successive corms. oath edual to the onginar term.
unl0as and until One or InO lDlldwing conditions peeure' 1) Inis [en,rinble ra peraonelly prlSMted for paYmrnl on a ma[ur,ly dale or within tan Oays Inpreeller; x) colt Dan4
recenes wnuen noGw ham a depositor Delore a maturity dale or the rMposilar's Intenridn Id redeem this cert~llcate, ~) nDI IDs Than 7 days Detpre a maturely date this Dana
msits lp eeposna rmten ny) de or .p mrention to redeem this cenifvate on a marunry date.
Interpn 8t the rare pr3 • ~ 5 ! 1 3.30 _ prr cent M annum lull be paid nili.•ll11.1~___
in rho manndr set Idnh bclpw II Ihls Cdnd~cale is aulnmat¢ally renewed, the mlerest rasa may cnangr on the renewal dale mr the sacceedmg penpd.
PAYYENT REOUEBTED:
^ 9YREMfrTINGeYMAILACRECKFORAMOUNTOFACCRUEDINTERE57 LXCREDItCNECKING 10_121-4
^ eY WMPUUNDMG SUGN INTEREST ANO PAYING SAMEAT TIMEOF PAY- ^ CREDI75AVINGS
MENT OF FACE AMOUNT REREOF ~' Tne aDOlre Werost ^td a staled as a simple anwal rate and does not take into
NOUry Vlis Dank irl!n!adiaraly dl any CDengr! In address. aCCDUnI the elle[I of wmpounding end d Dosed do a _ 365 day year.
rlgTF _?his C[mhcale will na[ eam interest ener mdlunry date unlgs n q renewed.
vets
•
f~ooz
CERTIFICATEe tv '=_z,~}~
S - ODO.UO
TYPE OF ACCOUNT:i
PERSONAL
~ f~ Individual
Joint - No Survivorship
U JDlni -With Survivorship
II Trust Aceount
V Subject to Separato Agreement Dated
^ Subject to Terms on [his form. Beneficiaries nomad below.
U Payable-On•Dea1h. Beneficiaries named below.
Name & Address of 9enefidiaries of Trust or Pay-On-Death
Accounts
FNB IN fiALSENBURG
TERM ~ a ~.. ~a..n.. ~.a~..~r.a...~ _. ~.~rcu ~..
DATE ISSUED '~= -~~> 19`~C MATURITY DATf ~ ~~~
ncenc!rno.er ~._.Utt~ CSoaT..cr Assl7rned to the
ADDRESS
Fier Nariorul Htrnk in Weleeoburi;
P.O. 13oz dd2
WelseaburE, Colorado 910851 NOTICE' TERM
L. Otto Goett!mPS A551grted to the S$$$e_ of
Col~orado~,_Naned Land Reclamation Poard -
~Pff.RB)
17
BUSINESS
Partnership O Corporation
U _.._
i ~ Aulnorizanon ~a;ed -..__....._..
p Number of Slgnalures required for withdrawal or other purpose.-
Disclosure give
ffr I nave read and under to ontlitions on the back
NOTICE Social Security or Fsnpfoyer's I.D. Number:
,& "Under Penalty of Perjury' I certity that the Soe. Sec. Number
shown above is my correol Taxpayer Identlflcatlon Number.
fr} "Under Penalty of Perjury' 1 cerllty that I am not subject t0 backup
withholding, either because 1 have not been noti}led that I am
subject to backup withholding az a rosult of a failure to report all
Interest or dividends, or the Internal Revenue Service has notified
me that I am ne Ion er subjrer to backup withholding.
~_-
EnOOrsements - (Sign when requesting withdrawal)
Data
X --- - -.... .._ Date
Date
REVERSE SIDE
~~
II
s nd the terms' d c