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U <br />AMERICAN NATIONAL BANK <br />1360 WALNUT STREET <br />BOULDER, CO 80302 <br />OWNERSHIP OF ACCOUNT - CONSUMER (Select One and Initial): <br />? Single-Party Account__ ? Trust-Separate Agreement <br />? Multiple-Party Accotint_ <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 Pa 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 ? PARTNERSHIP <br />? CORPORATION: ? FOR PROFIT ? NOT FOR PROFIT <br />® PUBLIC FUNDS <br />BUSINESS: <br />COUNTY & STATE <br />OF ORGANIZATION: <br />AUTHORIZATION DATED: _ <br />DATE OPENED BYELENA MALISHKIN <br />INITIAL DEPOSIT $ <br />? CASH ? CHECK ? <br />HOMETELEPHONE# 303-570-•6269 <br />BUSINESS PHONE# 303-443-0969 <br />DRIVER'S LICENSE# <br />E-MAIL <br />EM PLOYER <br />MOTHER'S MAIDEN NAME _ <br />Name and address of someone who will always know your location: <br /> <br /> <br /> NUMBER -The Taxpayer Identification Number <br />shown above (TIN) is my correct taxpayer identification number. <br />®B ACKUP 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: I certify under penalties of perjury the statements checked in this <br />section end th am a arson (includin?esident ienl. <br />?Z 7I <br />X oz? <br />M UNT ROYALE VENTURES, LLC (Date <br /> <br /> 344420 <br />ACCOUNT OWNER(S) NAME & ADDRESS <br />MOUNT ROYALE VENTURES, LLC <br />ASSIGNED TO STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PDPA #010004005101 <br />1313 SHERMAN ST RM 215 <br />DENVER, CO 80203 <br />? NEW ? EXISTING <br />TYPE OF ? CHECKING ? SAVINGS <br />ACCOUNT ? MONEY MARKET ® CERTIFICATE OF DEPOSIT <br />? NOW IN COD PUBLIC FUNDS <br />This is your (check one): <br />® Permanent ? Temporary account agreement. <br /> <br />Number of signatures required for withdrawal ONE <br />FACSIMILE SIGNATURE(S) ALLOWED? ? YES ® NO <br />X <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 veri <br /> 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 ? Funds Availability ? Truth in Savings <br />? Electronic Fund Transfers ? Privacy ? Substitute Checks <br />(1 ): X <br />RONALD CATTANY <br />I.D. # <br />(2). X <br />I.D. <br />(3). X <br />I.D. <br />(4). X <br />I.D. # <br />D.O.B. <br />7 <br />D.O.B. <br />AGENCY (POWER OF ATTORNEY) DESIGNATION (Optional): To Add <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 />©1992 Bankers Systems, Inc., St. Cloud, MN Form MPSC-LAZ-CO 4/19/2004 (page 1 of 2)