2007-05-23_REVISION - M1978222UG

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ate Taa Opened: 03/16/2005 Term: 12 Months ID:552-52-3842 Number: 605268 Certificate of Deposit Account Number: ;3050199 Amount of Deposit: One Thousand Four Hundred Twenty Dollars And No Cants ~ $1420.00 This Tame Deposit is Issued to: Issuer: _ - WIWAM E BURNETT ~ EVER(;12FBd NATIONAL BANK PUBLJC FUND ACCOUNT P.O. BOX 2020 PDPA # 010004005101 EVERGRFBJ CO 80439 1313 SHERMAN ST RId 215 ,DENVl32 CO 80203 - J Not Negotiable -Not Transferable -Additional terms are below. By Additional Terms and Disclosures This form contains the terms for your time deposit. It is also the Minimum Balance Requirement: You must make a minunum deposit to Truth-in-Savings disclosure for those depositors mhtled to one. There aze additional terms and disclosures on p e two of this form, some of open this account of $ 1.non.n0 this fotm lam or expand on those below. You should keep one copy of ® You must maintain this minimum balagce on a daily basis to earn the Maturity Date: This account matures 03/16/2006 annual percentage yield disclosed (See below for renewal information.) Withdrawals of Interest: Interest ^ accrued ® credited during a Rate Information: The interest rate for this account is 2.6500% term can be withdrawn: INTREST TRAN3FFJ7lD MONTHLY TO OOA with an aanual percentage yield of 2 68 %. This rate will be paid until the maturity date specified above. Interest begins to accrue on the business day you deposit any noncash item (for example, a check). Interest will be compounded Interest will be credited interest on the amount withdrawn. PtJ The annual percentage yield assumes that interest remains oa deposit Renewal Policy: until maturity. A withdrawal of interest will reduce earnings. ^ Single Maturity: If checked, [his account will not automatically ^_ If you close your account before interest is credited, you will not r®ew. Interest ^ will ^ will not accrue after maturity. receive the accnted interest. ~ ® Automatic Renewal: If checked, this account will automatically The NIIMBER OF ENDORSEMENTS needed for withdrawal or any renew on the maturity daze: (see page two for terms) other purpose is: RONALD W CATTANV ~ Interest ® will ^ will not accrue after final maturity. ACCOUNT OWNERSHHIP: (select one and initial) ^ Single Party Account ^ Multiple Party Account ^ Trust -Separate Agreement dated: ^ PUBLIC FUND Rights at Death: (select one and initial) ^ Single Party Account ^ Multiple Party Account with Right of Survivorship ^ Multiple Party Account without Right of Survivorship ^ Single Party Account with Pay on Death ^ Multiple Party Account with Right of Survivorship and Pay on Death Pay On Death Beneficiaries: To add Pay On Death Beneficiaries' name one or more: r Released and Make Payable Only To: William E Burnett Early Withdrawal Penalty: If we consent to a request for a withdrawal that is otherwise not permitted you may have to pay a penalty. The penalty will be an amount equal to: 1 AO dav~~pie interest. Social Security or Employer's LD. Number: A correct taxpayer identification number is required for almost every A certification of this number is also required and is contained on the fvst copy of this certificate. Backup Withholding - A cerificaton that you aze not subject to backup withholding is necessary for almost all accounts (except for persons who aze exempt altogether?. This ceRification is contained on the first copy of [his form. Failure to provide this certification when required will cause us to withhold a percentage of the interest earned (for payments to the IRS). Providing a false eSertificatlnn can result in serious federal penalties. }[ It ~w-wc~.. . _~ . -7 X RONat n w r•~Tl!!di-o Dlvtslon of Reclamation, Mining and Safggr X '1sr ' F~i'~-.e m 1993 Bankers Systems. Inc., S:. pou0, MN Form C6AA-LAZ-CO (1) 10/12/2001 State O~E TW~IY(IR'iONAL TERMS (page 1 of 7J