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FIRST NATIONAL BANK OF ELK RIVER ACCOUNT <br /> 729 MAIN STREET NUMBER <br /> ELK RIVER, MN 55330 <br /> (763) 241-3637 ACCOUNT OWNERIS)NAME 8 ADDRESS <br /> ELK RIVER MUNICIPAL UTILITIES <br /> OWNERSHIP OF ACCOUNT -CONSUMER PURPOSE 13069 ORONO PARKWAY NW <br /> ❑ INDIVIDUAL ❑ ELK RIVER MN 55330-5600 <br /> ( ❑ JOINT WITH SURVIVORSHIP land not as tenants rn common) <br /> El JOINT- NO SURVIVORSHIP as tenants rn common) <br /> ❑ TRUST •SEPARATE AGREEMENT <br /> Revised Date: 02/07/07 <br /> ❑ REVOCABLE TRUST OR ❑ PAY ON-DEATH CHANGE IN SIGNERS <br /> DESIGNATION AS DEFINED IN THIS AGREEMENT <br /> Name and Address of Benehciarres <br /> ❑ NEW El EXISTING <br /> TYPE OF ❑ CHECKING ❑ SAVINGS <br /> ACCOUNT El MONEY MARKET ❑ CERTIFICATE OF DEPOSIT <br /> ❑X NOW ❑ <br /> This is your(check one)• BUSINESS INT CKING <br /> El Permanent ❑ Temporary account agreement. <br /> Number of signatures required for withdrawal 2 <br /> OWNERSHIP OF ACCOUNT - BUSINESS PURPOSE FACSIMILE SIGNATUREIS) ALLOWED? ❑ YES ® NO <br /> ❑ SOLE PROPRIETORSHIP r X <br /> ❑ CORPORATION © FOR PROFIT CI NOT FOR PROFIT L <br /> ❑ PARTNERSHIP <br /> ❑ The undersigned agree to the terms stated on every page of this <br /> BUSINESS form and acknowledge receipt of a completed copy. The undersigned <br /> COUNTY &STATE further authorize the financial institution to verify credit and <br /> OF ORGANIZATION employment history and/or have a credit reporting agency prepare a <br /> 0 2/2 0/0 7 credit report on the undersigned, as individuals. The undersigned <br /> I AUTHORIZATION DATED also acknowledge the receipt of a copy and agree to the terms of the <br /> following disclosure(s): <br /> DATE OPENED 10/01/6 8 BY ANGEL GMYREK © Deposit Account ® Funds Availability ® Truth in Savings <br /> INITIAL DEPOSIT S © Electronic Fund Transfers ❑ Privacy © Substitute Checks <br /> ❑ CASH ❑ CHECK ❑ © Schedule of Fees <br /> HOME TELEPHONE N <br /> BUSINESS PHONE (763) 441-2020 <br /> I11: <br /> DRIVER'S LICENSE it X <br /> E MAIL JEROME A TAKLE <br /> EMPLOYER I.D. D 0 B <br /> MOTHER'S MAIDEN NAME D.L•# <br /> Name and address of someone who will always know your location _ 1 <br /> (2): LX <br /> Iif JAMES A TRALLE <br /> I D # D O B <br /> BACKUP WITHHOLDING CERTIFICATIONS D.L.# <br /> TIN: 41-6005125 <br /> (3) <br /> © TAXPAYER I.D. NUMBER - The Taxpayer Identification X <br /> Number shown above (TIN) is my correct taxpayer identification JERRY GUMPHREY <br /> number. <br /> I.D. # D O.B.14- <br /> © BACKUP WITHHOLDING - I am not subject to backup D.L. <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 (4) <br /> interest or dividends, or the Internal Revenue Service has notified X <br /> me that I am no longer subject to backup withholding DRYAN C ADAMS-- <br /> ❑ EXEMPT RECIPIENTS - I am an exempt recipient under the I D'a — " TaB- <br /> Internal Revenue Service Regulations. D.L.# <br /> SIGNATURE: I certify under penalties of perjury the statements ❑Authorized Signer Ilndtvtdual Accounts Only) <br /> checked in this section and that I am a U.S. person (including a X <br /> U.S. resident alien). L <br /> X <br /> (Date) <br /> I D # D O.B <br /> D.L.# <br /> FJC�ier�� 01992 Bankers Systems.inc.St Cloud MN Form MPSC LAZ-MN 4/19/2004 Ipaye 7 of 21 <br />