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his Certificate 'IC)DD K DYSART Evidences A ASSIC3~ 7l~ STATE OF ~ NILR BOARD Deposit In The p[]g1,IC FUNDS AC'Ct7UISP #010004005101 Certifica D/O/B Name(s) Of: 1313 SHERMAN ST RM 215 Account Number 4776 DENVER, Ct~ 80743 Date November 8, 2000 In The Amount Of Fifteen thousand and no/100* * * * * * * * * * * aouars S 15, 000.00 ACCOUNT TYPE AND TERMS - ONy the boxes that are checked and Ne lines that are filled in apply. Term (Ini[iall 365 days ^Additions permitted in a minimum amount of $ Mamriry Date (First) 11/08/2001 ~F'ixed Rate ^ Min. Balance Req. $ Interest Rate (Initial) 5.580 ryo ^ Variable Rau: Initial Index Rau % Maximum Rate % Compounded quarterly Minimum Rate % First Adjustment Date Interest Calculated actual /365 Adjustment Frequency No. Endorsements Required for Withdrawal 1 Rate Formula ^ Single MaNriry ~Aummatically Renewable Interest Paid quarterly First National Bank of Otis (a) ~By mailed quarterly by check 102 North Washington P. O. Box 72 (b) ^ ByDepositToAcct. No. /Ot~iSF ~ 8~)7~3-0072~(970)~4Fj-3456 ii DEFIMTIONS: "We" and "us" means the financial institution. "You" aad ' "your" means the deposimKs). "Certificate" means both this original instmmen[ as wdl as Ne deposit i[ shows. This artificare (and Ne account it represents) may not be transferred or assigned without our prior written consent and is not negotiable. VARIABLE Dd'FEREST RATE: Your deposit will eam interest a[ Ne initial interest rare stated on Nis certificau m Ne first adjusmrent date. Then, and on each succeeding adjustment dau, Ne rare Nis certificate will eam is subject m be increased oc decreased according to Ne formula described on Nis certificate. The rate will remain Ne same between interest adjustment dates. If the "first adjustment dau" is phrased in arms of "index change" Nis means Ne firs[ adjusmten[ dau and Ne rare adjustrnen[ frequency after Ne first adjusmrent dale are not regularly scheduled. In Nis case, Ne rate Nis certificate will eam will be adjusted any time Ne "index" changes. The inures[ rare we will pay on Nis certificau will no[, however, be greaur Nan Ne stated maximum mu (if any) or be less Nan Ne stated minimum tau (if any) regardless of changes in Ne index tau. COMPOUNDING: The compounding frequency and inures[ calculation method - will not change during Ne term of Ne certificate, regardless of adjustments [o Ne .interest tau, until we give reasonable notice m you of such change. ADDTTIONS: If we permit you m make any addidons, Ncy will oNy be permitted in an amount equal N, or greater Nan, Ne minimum amount indicated. The making of additions m Nis wrtificau will not exund Ne maturity of all, or any portion, of Ne funds on deposit. Additions will eam interest from Ne dau of deposit, and will mature at Ne same time as Ne first deposit. No additions may be Ta,.c '.c ~.,' Says o. .,.c .`.na: r..am ::~ ..„.. SINGLE MATURITY: If the single maturity box is checked, the depositor should present Nis certificate prompdy at maturity for payment. Inures[ ^ will ^ will no[ accme after maturity. AUTOMATIC RENEWALS: If Ne automatic renewal box is checked, Nis certificau will be automatically renewed afar Ne stated maturity dau stated for successive arms, each equal to Ne original arm. The inures[ rare will be Ne same we offer on new certificates on Ne maturity dau which have Ne same arm, minimum balance (if any) and other features as Nis original certificate. The deposimr may call us on or shortly before Ne maturity date and we will tell Ne depositor what Ne inures[ rate will be for Ne next renewal arm. The auNmatic renewal of Nis certificate may be prevented if one of Ne following Nings happens: (I) This certificau is personally presenud for payment on a maturity dau or within 10 days aher Ne maturity dau; or (2) We receive wdtten notice from Ne depositor before a maturity date of Nair inuntion to cash in this certificau. WILL S% wn.L NOT EARN INTEREST AFTER Only To: Iv when reaues[ina withd~~°"n' - NOTICE OF PENALTY FOR EARLY W1TfIDRAWAL Except as mentioned below, you cannot withdraw any principal from Nis account before a maturity date without our consent and we will charge a penalty. We can only consent m an early withdrawal at Ne time you request it. The penalty will be an amount equal to: * ^the greatest of: (1) aB of the interest earned on the amount withdrawn from [he most recent date of deposit or Iasi renewal, (2) aB the interest that coWd have been earned on the amount withdrawn during a period equal to one-half of the maturity period, or (3) seven days' interest on the amount withdrawn. ^ one month's interest on the amount withdrawn. ^three momhs' interest on the amount withdrawn. We will charge dre penalty first against any interest Nen in Ne account, atM any excess will be deducted from [he amount you withdraw. FIXED RATE TIME DEPOSITS: For a fixed rate time deposit we will use Ne nominal (simple inures[) rate in effect to calculate Ne amount of Ne applicable penalty. * See Addendum VARIABLE RATE TB1dE DEPOSIT: For any time deposit which earns a tau Nat may vary from time to time during Ne term, Ne inures[ rate we will use m calculate Nis inures[ forfeiture will be: ^average (weighted for time) of Ne simple inures[ taus earned on Nis cenificau up W Ne date of wihdrawal; ^ simple interest rate in effect on Ne dare Nat Nis account is opened; or, ^ Ne simple interest tau in effect on Ne dau of early withdmwal. Minimum Balance Account: If we require a minimum balance on Nis account, we may treat any withdrawal Nat reduces Ne balance below such minimum as a wi[hdmwal of Ne entire balance and calculate Ne penalty accordingly. EXCEPTIONS: Federal regWations permit, or N some cases requve, the waiver of the early withdrawal penalty if: (1) any account owner dies or is declared incompetent, or (2) this is an LR.A. or Keogh account and you are at least 59'h years of age or disabled at the time of the withdrawal request, or (3) this is an LR.A. or Keogh account and the request for withdrawal is made within seven days of establishing the account. (The penalty to such case wID be aB interest earned on the amount withdrawn.) p 1994, 1990 9aMers Systems, Inc., St. CIOUE, MN It-900-39J-23411 Form VFRCn-LAZ ]/24/94 VARIABLE/FIXED RATE TIME CERTIFICATE OF DEPOSIT /page J of JI Original