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RAND VALLEY NA'TIOXNAL BANK <br />925 N 7TH STREET <br />GRAND JUNCTION, CO 81501 <br />OWNERSHIP OF ACCOUNT - CONSUMER (Select One and Initial): <br />? Single-Party Account ? Trust-Separate Agreement <br />? Multiple-Party Account <br />? Other <br />RIGHTS AT DEATH (Select One And Initial): <br />? Single-Party Account <br />? Multiple-Party Account With Right of Survivorship <br />? Multiple-Party Account Without Right of Survivorship <br />? Single-Party Account With Pay On Death <br />? Multiple-Party Account With Right of Survivorship <br />and Pay On Death <br />PAY-ON-DEATH BENEFICIARIES: To Add Pay-On-Death Beneficiaries Name One or More: <br />OWNERSHIP OF ACCOUNT - BUSINESS PURPOSE <br />? SOLE PROPRIETORSHIP ?KPARTNERSHIP <br />? CORPORATION: ? FOR PROFIT ? NOT FOR PROFIT <br />BUSINESS: <br />COUNTY & STATE <br />OF ORGANIZATION: <br />AUTHORIZATION DATED: <br />DATE OPENED 4/15/2002 BY PEGGY <br />INITIAL DEPOSIT $ 9,646.00 <br />? CASH XX CHECK ? <br />HOME TELEPHONE # <br />BUSINESS PHONE # 303-866-4074 <br />DRIVER'S LICENSE # <br />E-MAIL <br />EMPLOYER <br />MOTHER'S MAIDEN NAiviE <br />Name and address of someone who will always know your location: _ <br />BACKUP WITHHOLDING CERTIFICATIONS <br />TIN: 84-6115837 <br />TAXPAYER I.D. NUMBER - The Taxpayer Identification Number <br />shown above (TIN) is my correct taxpayer identification number. <br />n BACKUP WITHHOLDING - I am not subject to backup <br />withholding either because I have not been notified that I am <br />subject to backup withholding as a result of a failure to report all <br />interest or dividends, or the Internal Revenue Service has notified <br />me that I am no longer subject to backup withholding. <br />? EXEMPT RECIPIENTS - I am an exempt recipient under the <br />Internal Revenue Service Regulations. <br />SIGNATURE: 1 certify under penalties of perjury the statements checked in this <br />section and t I am a U.S. person (including a U.S. resident. alien). <br />fAA1 (Date) <br />- 190o - 17F <br />ACCOUNT 10010947' <br />NUMBER <br />NAME & ADDRESS <br />MOORES MINING RANCHING & MILL ASSIGNED <br />TO THE STATE OF COLORADO/MLRB <br />1313 SHERMAN ST. ROOM 215 <br />DENVER CO 80203-0000 <br />M<NEW ? EXISTING <br />TYPE OF ? CHECKING ? SAVINGS <br />ACCOUNT ? MONEY MARKET CERTIFICATE OF DEPOSIT <br />? NOW ? <br />This is your (check one): i <br />Permanent ? Temporary account agreement. <br />Number of signatures required for withdrawal <br />FACSIMILE SIGNATURE(S) ALLOWED? ? YES <br />X <br />1 <br />MCNO <br />SIGNATURE(S) - The undersigned agree to the terms stated on every <br />page of this form and acknowledge receipt of a completed copy. The <br />undersigned further authorize the financial institution to verify credit <br />and employment history and/or have a credit reporting agency <br />prepare a credit report on the undersigned, as individuals. The <br />undersigned also acknowledge the receipt of a copy and agree to the <br />terms of the following disclosure(s): <br />Deposit Account :0 Funds Availability 9R Privacy <br />MCElectronic Funds Transfer Truth in Savings <br />(7 ): LX <br />MICHAEL B L G/ PUB C FUND 010004 <br />I.D. # D.O.B. <br />(2): IX <br />I.D. # <br />(3): LX <br />I.D. # <br />D.O.B <br />D.O B <br /> <br /> <br />(4)' [,X <br />1. D. # D.O.B. <br />AGENCY (POWER OF ATTORNEY) DESIGNATION (Optional): To A_d <br />Agency Designation To Account, Name One or More Agents: <br />(Select One and Initial): <br />? Agency Designation Survives Disability or Incapacity of Parties _ <br />? Agency Designation Terminates on Disability or Incapacity of Parties _ <br />EjJ5e_j:J?:; ©1992 Bankers Systems, Inc., St. Cloud, MN Form MPSC-LAZ-CO 11/18/2000 <br />BSIC0AP/C0MPSCZ1/AP0QA,??Q3of 2/