Laserfiche WebLink
9/2J/97 TUE 15:JJ FAZ 17197J8f~047 FNB IN {ir1LSENBURG C~j00J <br />• <br />TEAM 12 ~ IK] tM7:fEl~[Ma\EXA)~-]71A1.7E~7E-gs11-EE7:73.Y~:L•\-~ CERTIFICATE M _29823 ,~ <br />DATE fSSUED -B-ZO-97 MATURITYDA>'E 8 S _ 6.OSO.OO ,_ <br />'DEPOSITOR(S) Jacque Ci~JES[[OET/State of O~lorado.,; ~lrurt~ ~~~~g4 521-44-5857 <br />ADDRESS _ P•O. BOlc 115.5, Ta Veta, (17 81055 _ __ <br />CFHnFlFS pEDpSITFD SUM or <br />a SIX THOUSAND AND F.~R.'Y DOT,TARS AND 001100 - _ Do.LLAR ~ <br />~ PayaDleaf pre undarsignap'Jpanarnpoedx, rDSald Dep05rrpr.pr, ilmdre roan one, td ertherdrany Or Said Depositors drrneurrvnprS Orsunndr. upon presenrnlion and •Nrreni <br />~ or ma cwrDlrcate, property endorsed, an a merunn dare <br />S y^{~S~INGLE 4ATURITY: Present this cenmgte promptly ar mamrrty for pavmenl azit is norawortunoapy renewable and no ~nreresr wiu acaue abet me maturity date sho• <br />o pI\wUTOMATIC RENEWAL: This ttrtili[ate matures an maturity gale stored dbpve, but will automaUdally be renewers tar successive terms. mcn equal ld rho original rot <br />-- - pnley5 and poor one M rite Ipllpwing pOitdNdnb OfLUra' 1) ITe CCrldiUle is persondlly preetlnred br Daymenl an a malurnY dare or wnhm ien days nc~reaher. Z) Ines ea <br />renewer wr~nen noGtt Boma tleposaor cetorea ma[unty date of the tleDOSnOrcmUmion to redeem Init. crrrJirale:3)ndt lesa roan ]days bemrea mawnry date lha ba <br />mail} Iq deppSdpr Maslen ndripe of ue iMr!nridn Id rlde¢m INS eerttlrna[e do a malUrlty date. <br />- TarMr <br />Ime.esr ar u. rare or _r2_. 30~~~ ~_ p.r «m ear nnnom roan ee wm OI 1~ _ <br />~ m Ne manner sal lorlh DClow. II IAic Cenibcare Is automalicahy renewed. rite imeresl Y,IIe may change on me renevnl dale rot me succeeding oenaa <br />8 PA'IYENT REOUES'rEO: <br />C f' BY RELIRTING 9Y MAIL A CHECK FOR AMOUNT OF ACCRUED INTEREST ^ CREDIT CI+ECRrNG <br />f 7Q[BY COMPOUNDINGSUGR INTEREST ANO PAVING SAME AT TIME OF PAY- ^ CREDIT SAVINGS <br />^ MENT OF FAGS AMOUNT HEREOF [J Ton abdvC imeresl rase ~s 901ed as a simple annual rase pylorc nor qte n '. <br />B Notify Ims Dank immediately er any cnanq! In addre56. ampum We efleer dl rnmpeund~ng and ~s based on a ~ Oa e <br />YY <br />NOT ^~s CeihtySlc will npl eem inle!!el fiber malunly dale unltt; it is renew[ <br />l•VrnOR12Eu sIUN.*unq <br />NOTtCf: TERM AND CONDITIONS ON REVERSE SIDE <br />FIRSC NATI~L BANK IN WALSENBURG <br />TYPE OF ACCOUNTS <br />PERSONAL BUSINESS <br />Y7 Individual ^ Partnership ^ Cgrporatrpn <br />~ <br />^ Joint - No $UrvivOrship ^ _ <br />^ Jgrn1-WIN $urvlvorship ^ Authorizanon Oaled _... <br />0 Trust ACCDIInI ^ Number 01 $ignalures requlretl for withdrawal or other purpoee _ <br />^ Subject to Separate Agreement Dated ...._ I nav and understand N [arms and cond;[lons on ne back. ' <br />^ Sub(ect to Terms on this loon. Beneficiaries named 6clow. X <br />_ <br />PayaDle-0n-DeaN. BCneficiarle; named below <br />^ X ___- <br />NOTICE: Spolal Secunry or Employer' umber ••Under P natty of Perjury" 1 nertiry that the Soc. Sec. Number shown abovA rs my corre~ <br />Tazpayer Idenlfication Number. %- - -~=~d~~ _. .. __ <br />UNDER PENALTIES OF PERJURY I CERTIFY AT 1 AM NOT SUBJECT TO BACKUP W ITHROLDING, either because I havo nor been notified Thal <br />am subject to backup wllhholding a: a r 1 a [allure to repon a Ylnteresl or dividends. or the vernal Revenue Service hac notified mC Ihal I am n <br />longer wbjen to backup withholding. .. - . _ <br />Name 8 Address pf BBneGclatie5 01 Trust or -0n-Death Accounts EndorsCmenls - (Sign whCn requesting wlthdrawalJ <br />.LA <br />ta11 <br />di V7 dEd % Dare -... <br />~ <br />~~ , <br />X ~.. .. _ Date <br />_. ... . _.. _._ X _ .. ^ztr ...- <br />i, <br />