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Mone Market Account <br /> ACCOUNT <br /> EverTrust Hank NVMBEFI 5150255041 64325 <br /> 2707 Colby Avenue <br /> EveTEtt, WA 98201 ACCOUNT OWNERISI NAME 6 ADDRESS <br /> E 6 A Ennrpdsa LtC <br /> 6ie T J�cohs�n,:ipnn <br /> OWNERSHIP OF ACCOUNT-CONSUMER PUflPOSE Assinpm�nt ol Fun�Y <br /> ❑ SINGLE ACCOUNT ❑ <br /> ❑ JOINT-WITHSURVIVOflSHIP '�n4nat���enanuincanmon 1170237MSt5E <br /> n canmumry C�ao���vl <br /> ❑ JOINT-NO SURVIVOflSHIP laa temnu m�ommoni <br /> ❑ COMMUNITV PflOPEFTY ACCOUNi Snahamish,WA 98290�0000 <br /> ❑ TRUST-SEPAFATE AGPEEMENT: <br /> HEVOCABLE TfiUST OR PAY�ON�DEATH <br /> DESIGNATION AS DEFINED IN THIS AGREEMENT � NEW ❑ EXISTING <br /> Neme and Addross ol BeneNciaries: TYPE OF ❑ CHECKING ❑ $AVINGS <br /> ACCOUNT � MONEY MARKET ❑ CERTIFICATE OF DEPOSIT <br /> ❑ NOW ❑ <br /> This is ya,r(check onel: <br /> � Permanent ❑ Temporary account agreement. <br /> Number of signatures reQuired tor withdrawal 1 <br /> FACSIMILE SIGNATUREISI ALLOWEDI ❑ YES � NO <br /> OWNERSHIP OF ACCOUNT-BUSINE55 PURPOSE <br /> ❑ SOLE PROPflIETORSMIP <br /> ❑ CORPOflATION: ❑ FON PpOF1T ❑ NOT FOfi PROFIT �X \—/� � <br /> ❑ PAP7NEFSHIP SIGNATUREISI-The undersigned agree to the terms statad on every <br /> pege of this torm end acknowledge receipt of e tompleted capy.The <br /> �] Limit�d Liability Company undarsigned further aufhoriza the financiel inatitution to veriry credit <br /> BUSINE55: end emplcyment history end/or have e credit reporting egency <br /> COUNiV 6 STATE prepera a credit report on tha under�fgnad, as individuela. The <br /> OF OPGaNI2A710N: underaignsd elso seknowled�e the receipt ot a copy end egrea to tha <br /> AUTNOliIZATION OATED: 02�24�20OJ tefTf Of th!fo110Wlllg dlSClo9ufa�l�: <br /> � Deposi[Account � Funds Availa6ility <br /> DAiEOPENED 02/24/2003 gyMelonieGrieser � ElectronicFundsTrensfer � TruthinSavings ❑ Prrvacy <br /> INITIALOEPO5IT! 4,200.00 � Privacy Disslosure <br /> ❑ CASM ❑ CHECK � trans�Et <br /> MOME TELEPMONE� �� %/ �L \ 1 <br /> BUSINESSPNONEr 4Z5-330-0444 ���' � (/` �� J <br /> DRIVER'SUCENSER ���� -tricThroten <br /> E�MAIL �,p. p 533-84-1756 o.0.g. 03/24/1964 <br /> EMPlOVER <br /> MOiHER'S MAIDEN NAME �Z 601 912 170 1 <br /> 121: J <br /> Name ana atlCress ai someane w�o wiil alwflys tnaw your location: _ R <br /> I.D. # D.O.B. <br /> BACKUP WITHHOLDING CEHTIFICAI'IONS � � <br /> TIN: 91-2043409 131: X <br /> � TAXPAYER I.D, NUMBEfl • The Taxpayer ldenti�iwtlon <br /> Number shown above ITINI is my cortect taxpayer identi(ica[ion I.D, p D.O.B. <br /> number. <br /> � BACKUP WITHHOLOING • I am not suhject to hackup �x 1 <br /> wlthholdmg either bewuse I have not been notified that I am �4�� 1 <br /> subject to backup withholding as a resWt of a failure ta report all J <br /> interest or dividends, or the Internal Revenue Service tas noti(ied <br /> me iha[I am no longer subject ta 6ackup withholding. I.D. p D.O.B. <br /> ❑ EXEMPT RECIPIENTS • I am an exempt recipient under Ihe <br /> Intemal Revenue Service Regulations. ❑Agen[IS�ngie Accounts Only1 INamel <br /> SIGNATURE: I certify undn p�n�16u of pujury N�suromena ch�o4ed in Uis rx 1 <br /> su]lon�nd thn I am pe n fincludinp�U.S.rosid�nulienl. � � <br /> � <br /> x /,'� „Lt/� oz/za/zoo? <br /> �-' � � IDatel �,D.x D.o.B. <br /> FjcFt� .^,199]B�mm�Sv����.�ne..SLCIOW.MN FormMP5C�U2�WA 11R]2000 Io�f 1 r71 <br /> 1� <br />