2005-03-03_REVISION - M1992038 (2)

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a'd. '° - - Tax .~~~ 11388 `` Certll1Cate Of DepQSlt. Account Number: 12 N}ONIII CD Artiouut of ~ ~ - Deposit: `Four thousand flue hundred and I70/100* * * * * * * * * * * *-* This Tithe Deposit is Issued to: ~ - ~ Issuer: AUTI30RIZED SIGNER:;._DIVISIONS DIRECTOR BANK OF C071JRAD0 PDPA 0100040051010 MICHAEL ,B.. LONG 301 CCd.YTY)N STREET P ~~SADID CREEK FARMS INC - ~- BRUSH, ~ 80723 ASSIC3QID `I1~ (970) 842-2844 $ 4,500.00 O. BOX 525 STATE OF ~TJJRADO/MIDfED LAAID RECLAMATION MAIL: 1313 Sherman St., Room 215 BOARD Denver, Co. 80203 .P O BOX 404, BYERS, 00 80103 Not Negotiable -Not Transferable -Additional terms are below. By This form contains the terms for your time deposit It is also the Minimum Balance Requirement: You must make a minimum deposit to Truth-in-Savings disclosure for those deposimrs enttded m one. There are additional terms and disclosures on page two of dtis form, some of open this account of $ 500.00 which explain or expand on those below. You should keep one copy'of this form. ~~;Yop must maintain this minimum balance on a daily basis m earn the Maturity Date: This account matures July 30, 1999 - annijal percentage yield disclosed. (See below for renewat information:). Withdr'a'~eals of Interest: Interest ^ accmed ~ credited during a f~~T.: Rate Ihformation: The interest rate for this account is 5.320 % term can be" withdrawn: before 1t1ati1rltV of that ternt with an annual percentage yield of 5.43 %. This rate will be wttioiit"S~penalty ' paid until the mamrity date specified above. Interest begins.fo accrue on„ Earlyw,Withdrawal Penalty: If we consent to a request for a withdrawal [he business day you deposit any noncash item (for example; a check). ~"'~ that is otheriYise°'not permined you may have m pay a penal[;. The Interest will be compounded quarterly penalty.will be'an;amount equal to: one ironth' s Interest will be credited quarterly "to aCCOttnt titunber •--~ ~~ 4100025070 "'`' `'sz'"' interest on the amount withdrawn. The annual percentage yield assumes that interest remains on deposit RenewahPolicy: until mamrity. A withdrawal of interest will reduce earnings. " ^'~ Single fMaturity: If checked, this account will not automatically ^ If you close your account before interest is credited, you will~not renew. Interest ^ will ^ will not accme after mamrity. receive the accrued interest. ~"."Automafic Renewal: If checked, this account wdl automatically The NUMBER OF ENDORSEMENTS needed for withdrawal or any renew on the maturity date. (see page two for terms) other purpose is: 1 Interest ^ will ~ will not accrue after final maturity. ACCOUNT OWNERSHIP: (select one and initial) $$ Single Party Account ^ Multiple Party Account ^ Tmst -Separate Agreement dated: Rights at Death: (select one and initial) $g Single Party Account ^ Multiple Party Account with Right of Survivorship ^ Multiple Party Account without Right of Survivorship ^ Single Parry Account with Pay on Death ^ Multiple Party Account with Right of Survivorship and Pay on Death Pay On Death Beneficiaries: To h Beneficiaries' name one or more: , Social Security or Employer's LD. Number: A correct taxpayer identification number is required for almost every type of account. A certification of thts number is also required and is contained on the first copy of this certificate. Backup WitMOmmg - A CertltlCanon ma[ you aIe no[ subject to backup withholding is necessary for almost all accounts (except for persons who are exempt altogether). This certificauon.is contained on the first copy of [tits form. Failure to provide this certification when required will cause us [o withhold 31% of the interest earned (for payments to the IRS). Providing a false certification can result in serious federal penalties. X Ronald W. Cottony, Division D' ector X Office of Mined Land Reclamation O 1993 Bankers Systems, Inc., St. Claud, MN I1-600-39]-23d1) Form CD-AA-CO n) ]/26/96 ~-i~i nal READY'ADE'I1V0 FOR ADDI1'IONAI' TERMS !Page 1 n/21