2007-11-26_REVISION - M1987088 (7)

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ERTFICATE OFTIME DEPOSIT -NON-NEGOTIABLE AND NON-TRANSFERABLE nCiuni EIRA+E 20005 ISSUED TO NAMEIS) AND ADDRESS(ES) OF OEPOSITOR(SI ('you, your) o NAME AND ADDRESS OF ISSUERIFINANCIAL INSTITUTION I'we, us") ed R {v ?S Fami,y Trust IOCC?o MAINTHE BANK OF DJ2ANG0 ss? I?'F C/O Dl=of Minerals & Geology PO BOX L C1? 1313 Sherman St Rm 215 DURANGO, CO 81302 Denver CO 80302 ?E} btuxj4o0S 1 L) I ?B.. /vb?_ S.S. rIT.I.N. ISSUE DATE MATURITY GATE X AUTOMATICALLY RENEWABLE TERM rabj T CERTIFI 1336-10-1853 12/12/00 112/12/01 SINGLE MATURITY 12 MONTH o 4, 7 0 0Cftl IN THE AMOUNT OF Four thousand seven hundred & no/100 er DOLLARS INTEREST RATE. The deposit evidenced by this Certificate will earn an annual interest rate of 6 . 0 0 0 % Annual Percentage Yield t2111 8 % Interest Payment Frequency _quarterly which will be xa credited to account number 58319 a paid to depositor(s) by check 'Oded to principal of this Certificate. Interest will be calculated on a basis of a] 365 days ? Other . Interest will be compounded daily EARLY WITHDRAWAL PENALTY: 90 Days Interest on the amount withdrawn U Grace Period ? business ? calendar days. a If this is an automatically renewable certificate which is withdrawn during the grace period, the interest rate for the grace ape ' d will b x 0 . 0 0 rate of interest that would have been paid on this Certificate if renewed. Z X AUTHORIZED SIGNATURE OWNERSHIP OF ACCOUNT AND RIGHTS AT DEATH (Consumer) (Select One and Initial): ? Single Party ? Single Party with Pay on Death ? Multi-Party with Right of Survivorship ? Multi-Party without Right of Survivorship ? Multi-Party with Right of Survivorship and Pay on Death If account has a Pay on Death feature, name beneficiary(fes): % 7 the same PUJD/ , RVV)? OWNERSHIP OF ACCOUNT (Business): ? Sole Proprietorship ? Partnership ? Corporation ? Limited Liability Company 0 Other Trust TAXPAYER IDENTIFICATION NUMBER CERTIFICATION Under penalties of perjury, you certify that: (1) the number shown above is your correct taxpayer identification number, and 12) you ere not subject to backup withholding because: (a) you are exempt from backup withholding, or (b) you have not been notified 71 by the Intemal Revenue Service (IRS) that you are subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified you that you are no longer subject to backup withholding. INCITE: You must cross out clause 121 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends an your tax tslum.) APPLIED FOR DECLARATION a Under penalties of perjury, you certify (11 that a taxpayer identification number has not boon issued to you, and that you mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office for you intend to mail or delver an application in the mar future). You understand that if you do not provide a taxpayer identification number to us within sixty (SO) days, we an required to withhold federal inoartr taxes on ell reportable payments thereafter made to you until you provide a vsfid member and that other penalties may apply. The amount of federal income taxis witldrld will he detamaimd by applying the applicable backup withholding rata, as established by the Internal Rover= Service, to the reportable payments. (2) That you are not subject to backup withholding either because you have not been notified that you are subject to backup withholding as a result of a failure to sport OR interest or dividends, or the Internal Revenue Service has notified you that you axe no lonpar subject to backup withholding. INCITE: If we have been notified by the Internal Revenue Service that we are subject to backup withholding and have not been notified that backup withholding his been torminsted, then we must strike out claw (2) above). SIGNATURE ACKNOWLEDGMENT By making this deposit, the Depositor(s) greets) to the Tema and Condition stated on pore 1 and his taken special notice of the discussion of Early Withdrawal Penalties which apply to this deposit included in the Tema and Conditions By signing balm, Depositorls) acknowledge(s) receipt of ccount Nutosure related to this Account L_??? X is ae Division o mere s an Geolpy OEPOSITORSIGNATUREIOATE Office of Mined Land Reclamation X zitate o 9F& TUREIOATE DEPOSITOR SIGNATUREIOATE The a tor(sl acknowMNs) receipt of fends n REDEMPTION t? tip present.e by this Grtificate Of two Deposit. Y DEPOSITOR SIGNATUREIOATE DEPOSITOR SIGNATUREIOATE X A DEPOSITOR SIGNATUREIOATE DEPOSITOR SIGNATUREIDATE ITEM 57ecOL2 (98101 (73118) Papa 2 or 2 FINANCIAL INSTITUTION COPY Copyright Compliance Systems, Inc. 1991, 1996, 1997, 1998