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HIS CERTIFICATE <br />EVIDENCES A <br />DEPOSIT IN THE <br />NAME(Sl OF. <br />IN THE AMOUNT OF <br />61ake ni d Company for use by Niined Land O O <br />ReClama~ 303rd • Certificate Number o 0 9 <br />Jlox 741, ~ucla~ CO 81424 Account Number 8874-35 <br />f~~~~~ ~ P'~ I<~ .")!".! y~~q i...n Date ,Tull 29 . 19g~ <br />IY i ~UiYIY C:v:i~ ~!h..,. ~!;,,,i! !;,.,i) n' m'' .:.. ~.: :.....I ~i'm!II ~ 6,. r ~.! <br />DOLIARSS 2 650 00 <br />TERM. MATURITY AND DESCRIPTION: This cemficate has a term of nn o 3ro a r _ <br />r <br />II will ((irsU mature an Tn 1 v 79 . I9 _$_~ <br />The minimum balance is 8 2 r 6S0 .-00 <br />INTEREST: Your deposit will eam interest at the rate of 6_5 % per year to the first maturity date. We calculate interest using the .~(].rj'L <br />days per year method. We will compound interest laccrue interest on interest) „~ <br />We vnll pay interest _~kyg.~gg~l3 (mail Check ob1• t0 Blake :41n1R? CO.) <br />The interest rate we well pay on automate renewals o(this certificate will be the same rate we offer on new czrtificmes on the maturity date which have the <br />same term. minimum balance. and other charauenstics as this original certificate. You may call us on or shortly before the maturity date and we can tell you <br />what the interest rate Hnll be for the next renrval term. <br />YOOR DEPOSlT WELL NOT EARN INTEREST AFTER 7HE MATURITY DATE UNDER 7HI5 CERTIFICATE (UNLESS 1T IS RENEWED). <br />RENEWALS: ~( 1( checked. we will automatically renew this cerifcate on each <br />succeeding maturity date. Fach renewal term will be the same as the original Montrose County Bank <br />term, beginning on the matunty date. We will not automatically renew this <br />certificate (U i(you tell us not to do so, in writing, on or before the nett maturity Naturita, Colorado 81422 <br />date. or Ql i(you present this certificate to us (or payment (or other disposition) ,~ ~ <br />on or within 10 calendar days alter the matunty date. ~.. <br />SINGLE MATURITY: ^ If checked. we will not automatically renew this certificate. ' <br />It will mature once on the matunty date. <br />PERSONAL ACCOUNTS: You have requested and <br />intend the type of account marked below. <br />^ Individual <br />^ Joint Account - Wnh Survivorship <br />^ Multiple Depositors - No Survivorship <br />^ Tmst Account <br />^ Subject To Separate Agreement <br />Dated <br />^ Subject To Terms On This Form <br />Beneficiaries Named Below <br />^ Pay-On-Death <br />Beneficiaries Named Below <br />RENEFiCIARIES <br />OF IR057 OR <br />-PAY-ON•DEATN <br />ACCOUN75 <br />~ NON•PERSONAL ACCOUNTS: Depositor is a: <br />^ Partnership ^ Corporatlon <br />Authorization dated <br />The NUIYtBER OF ENDORSEMENTS needed <br />(or withdrawal or any other purpose is: 1 <br />S) ~YFl ePrvnE/+S S~SrE+/S irvC.Sr QOUO '~h buL.i CViuB CJ ii lit ]/5/9a <br />531-30-6388 <br />SOCIAL SECURRYOR EMPLOYER'S LD. NOhIDER• <br />A correct taxpayer idenfification number is required for <br />almost every type of account. A certification of this <br />number is also required and is contained on the first <br />copy of this certifcate. <br />BACRIIP WIiI{HOLDING -A certification that you <br />are not subject to backup withholding is necessary <br />for almost aLL accounts (except for persons who are <br />exempt altogether). This certfiraton is contained on the <br />first copy o(this form. Failure to ptaride this certification <br />when regwred will cause us to withhold 20% of the <br />interest earned Ifor payment to the IRS). Providing a <br />false certification can result N serous federal penalties. <br />RELEAS ~ ifADE PAYABLE TO BLAKE HI2iING CO. <br />x <br />. , ec or <br />)Divisior. Df Hinerals an <br />State of Colorado February 26, 1998 <br />