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%rnT1[I1% ATC nC TIaAC nrnnOIT _wanwr kirf_%t?TIAQI C AA1r% 1Uf11U-70 ARICCCRARI C CERTIFICATE 22133 <br />ISSUED TO NAME(S) AND ADDRESSIES) OF DEPOSITOR(S) ("You, your' NAME AND ADDRESS OF ISSUERIFINANCIAL INSTITUTION ("we, us") <br />Shalako International THE FIRST NATIONAL BANK OF DURANGO <br />Assigned to State of Co Mined Land MAIN OFFICE <br />1313 Sherman St Rm #215 PO BOX 2910 <br /> DURANGO, CO 81302 <br />Denver CO 80203 <br />S <br />I <br />N <br />S <br />rIT ISSUE DATE MATURITY DATE X AUTOMATICALLY RENEWABLE TERM AMOUNT OF CERTIFICATE <br />. <br />. <br />. <br />. <br />. <br />88-0134888 1 4/07/03 1 4/07/04 SINGLE MATURITY 12 MONTHS 421.00 <br />IN THE AMOUNT OF Four nunarea twenty one 6c no/.Luu <br />INTEREST RATE. The deposit evidenced by this Certificate will earn an annual interest rate of 1 . 7 5 0 <br />Interest Payment Frequency quarterly which will be ? credited to account number <br />principal of this Certificate. <br />Interest will be calculated on a basis of X? 365 days ? Other Interest will fie compounded da i 1 <br />EARLY WITHDRAWAL PENALTY: 90 Days Interest on the amount withdrawn <br />vv??e+ny <br />% Annual Percentage Yield 1.76 4 <br />paid to depositorls) by check ? added to <br />x? Grace Period • Automatically Renewable Certificate: 10 days. If this Certificate is withdrawn during the grace period, the interest rate will be <br />a 0 . o o %. ? the same rate of interest that would have been paid on this Certificate if renewed. X? interest will not be paid during the grace period. <br />? Post-Maturity Interest • Single Maturity Certificate: The interest rate paid on the deposit after the Maturity Date will be ? <br />? interest will not be paid after the Maturity Date. ? <br />OWNERSHIP OF ACCOUNT AND RIGHTS AT DEATH (Consumer) (Select One and Initial): &,- <br />1-1 Single Party ? Single Party with Pay on Death ? Multi-Party with Right of Survivorship <br />? Multi•Party without Right of Survivorship ? Multi-Party with Right of Survivorship and Pay on Death <br />If account has a Pay on Death feature, name beneficiary(ies): <br />OWNERSHIP OF ACCOUNT (Business): <br />? Sole Proprietorship ? <br />0 Other <br />NUMBER OF SIGNATURES REQUIRED: <br />TAXPAYER IDENTIFICATION NUMBER CERTIFICATION <br />/1U.t..rnaI der penalties of perjury, I comfy that (1) the number shown above is my correct taxpayer identification number, and (2) I son not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the <br />Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and I am a U.S. person (including a U.S. resident <br />(NOTE: You must cross out clause (2) 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 on your tax return.) <br />F1 Applied for TIN. Under penalties of perjury, I certify that a TIN has not been issued to me and I have applied or intend to apply for a TIN. I understand that if do not provide a certified TIN to this institution with 80 days, the institution is required by <br />federal regulation to withhold 31 percent of any interest payments made to me until I provide the certified TIN to the institution. <br />Exemption. Under penalties of perjury, I certify that I quality for exemption from withholding on interest and dividends under one or more definitions of "Payees Exempt From Backup Withholding" or "Payments Exempt From Backup Withholding" as sat forth <br />in the "Instructions for the Requester of Form W-O." <br />? Foreign Recipient. I have provided this institution with the appropriate Form W-8 certification. If a joint account, each joint account owner has provided the appropriate Form W-8 certification. If any one of the joint account owners has not established <br />foreign stetus,,,thafivWr cmkunt owner has provided this institution with a certified TIN. <br /> <br />Partnership ? Corporation ? Limited Liability Company <br /> <br />Taxpayer Identification Number: 88-01.341:11:111 <br />?, j??;? z J` ?r <br />GATE <br />ACKNOWLEDGMENT <br />By making this deposit ep or(s) ,reels) to the Terms and Conditions stated on page 1 and has taken special notice of the discussion of Early Withdrawal Penalties which apply to this deposit included in the Terms and Conditions. By signing below, Depositor(s) <br />acknowledge(s) ra t of an A ount Di:sclosure related to this Accou t <br />V rz X? . <br />? ?/QnAIGf ?gpsKpF„S?UREIDATE DEPOSITOR SIGNATUREIDATE <br />DEPOSITOR SIGNATUREIDATE DEPOSITOR SIGNATUREIOATE <br /> <br />CIRIAIIIPIAI II11@TITIITInAI PODv n^__.._ ^^? .^^? ^^^^