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Resolution 5568 - AMENDS RESO 5383 - Authorizing Signatures on Bank AccountBE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF KALISPELL, MONTANA, AS FOLLOWS: SECTION I. See Exhibit "A", attached hereto and thereby made a part hereof. SECTION II. This Resolution shall become effective immediately upon passage by the City Council and approval by the Mayor. PASSED AND APPROVED BY THE CITY COUNCIL AND SIGNED BY THE MAYOR OF THE CITY OF KALISPELL THIS 18TH DAY OF JUNE, 2012. Tammi Fisher Mayor ATTEST: �e Theresa White City Clerk 210t MAIN STREET KALISPELL, NIT 59901 (406) 756-4200 OWNERSHIP OF ACCOUNT - CONSUMER (Select One and Initial): i ❑ Single -Party Account ❑ Multiple -Party Account ❑ Trust -Separate Agreement Dated: ❑ Other CHANGING TERMS OF ACCOUNT (Select One and Each Party Initial): ❑ Multiple -Party Account's terms may be changed by a single party ❑ Muitipie-Party Account's terms may be changed only by agreement of all parties RIGHTS AT DEATH (Select One and Initial): ❑ Single -Party Account ❑ Multiple -Party Account With Right of Survivorship ❑ Multiple -Party Account Without Right of Survivorship ❑ Single -Party Account With Pay On Death ❑ Multiple -Party Account With Right of Survivorship and Pay on Death PAY-OWDEATH aENEF€C€ARIES: To Add Pay -On -Death Beneficiaries Name One or More: OWNERSHIP OF ACCOUNT - BUSINESS PURPOSE ❑ SOLE PROPRIETORSHIP ❑ PARTNERSHIP ❑ LIMITED LIABILITY COMPANY ❑ CORPORATION: ❑ FOR PROFIT ❑ NOT FOR PROFIT © Public Funds BUSINESS: CITY OF KALSIPELL FUNDS .OUNTY & STATE FLATHEAD MT F ORGANIZATION: AUTHORIZATION DATED: 06/11/12 DATE OPENED 03/07/02 By LIANA PURDY INITIAL DEPOSIT $ ❑ CASH ❑ CHECK ❑ HOME TELEPHONE# (406) 758--7700 BUSINESS PHONE # (406) 758-7700 DRIVER'S LICENSE # E-MAIL EMPLOYER MOTHER'S MAIDEN NAME Name and address of someone. who will always know your location: BACKUP WITHHOLDING CERTIFICATIONS TIN; El TAXPAYER I.D. NUMBER - The Taxpayer Identification Numbar shown above {TIN) is my correct taxpayer identification number. © BACKUP WITHHOLDING - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. ❑ EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue Service Regulations. SIGNATURE. I certify under penalties of perjury the statements checked in this zection and that I am a U.S. citizen or other U.S. person (as defined in the structions). 0 Signature Card -MT Bankers Systemsm Wolters Kluwer Financial Services Q 1992, 2008 ACCOUNT DUMBER ACCOUNT OWNER(S) NAME & ADDRESS CITY OF KALISPELL FINANCE DIRECTOR PO BOX 1997 KALISPELL MT 59903-1997 35 FIRST AVE E Reprised Date:06/11/12 ADDING AND REMOVING SIGNERS C005076 ❑ NEW EXISTING TYPE OF © CHECKING ❑ SAVINGS ACCOUNT ❑ (MONEY MARKET ❑ CERTIFICATE OF DEPOSIT ❑ Now ❑ This is your (check one): GLACIER BUSINESS CK 0 Permanent ❑ Temporary account agreement. Number of signatures required for withdrawal 1 FACSIMILE SIGNATURE(S) ALLOWED? ❑ YES X ® NO 51GNATURE(S) - The undersigned certifies the accuracy of the information hefshe has provided and atknawfedgas receipt of a completed copy of this form. The undersigned authorizes the financial institution to verify credit and employment history andlur have a credit reporting agency prepare a credit report on the undersigned, as individuals, The undersigned also acknowledge the receipt of a copy and agree to the terms of the following agreementls) andjor disclosure(s): © Terms & Conditions ® Truth in Savings ® Funds Availability © Electronic Fund Transfers ❑ Privacy A Substitute Checks Common Features ❑ DEBRA J DEIS'T" DOUGLAS R RUSSELL RICHARD G WILLS I.D. # (4): Ix DA-8, D.Q.B. D.O-B I.Q. # D.O.B. AGENCY (POWER OF ATTORNEY) DESIGNATION (Optional): To Add Agency Designation To Account, Name One or More Agents: !Select One and Initial): ❑ Agency Designation Surv-Ives Disability or Incapacity of Parties ❑ Agency Designation Terminates on Disability or Incapacity of Parties MPSC-LAZ-MT 10f112009 Page 1 of 1 jGLACIER BANK Q 2-:?vIAIN STREET TCALISPELL, MT 59901 (406) 756-4200 OWNERSHIP OF ACCOUNT - CONSUMER (Select One and Initial): ❑ Single -Party Account ❑ Multiple -Party Account ❑ Trust -Separate Agreement Dated: ❑ Ofher CHANGING TERMS OF ACCOUNT (Select One and Each Party Initial): ❑ Multiple -Party Account's terms may be changed by a single party ❑ Mnitiple,Party Account's terms may he changed only by agreement of all parties RIGHTS AT DEATH (Select One and Initial): ❑ Single -Party Account ❑ Multiple -Party Account With Right of Survivarship ❑ Multiple -Party Account Without Right of Survivorship ❑ Single -Party Account With Pay On _Death ❑ Multiple -Party Account With Right of Survivorship and Pay on Death PAY -ON -DEATH BENI:PICIARIES: To Add Pay -On -Death Beneficiaries Name One or More: OWNERSHIP OF ACCOUNT - BUSINESS PURPOSE ❑ SOLE PROPRIETORSHIP ❑ PARTNERSHIP ❑ LIMITED LIABILITY COMPANY ❑ CORPORATION: ❑ FOR PROFIT ❑ NOT FOR PROFIT © Public Funds BUSINESS: CITY OF KALISPELL FUNDS 'OUNTY & STATE FLATHEAD MT )F ORGANIZATION: AUTHORIZATION DATED: 06/1 /12 DATE OPENED 12 / 19 / 0 5 By JANA PURDY INITIAL DEPOSIT $ ❑ CASH ❑ CHECK ❑ HOME TELEPHONE# (406) 758-7700 BUSINESS PHONE # (406) 758-7700 DRIVER'S LICENSE # E-MAIL EMPLOYER MOTHER'S MAIDEN NAME Name and address of someone who will always know your location: BACKI Ira WIT141-4nr r)l€vC CERTIFICATIONS TIN: © TAXPAYER I.D. NUMBER - The Taxpayer Identification Number shown above (TIN) is my correct taxpayer identification number. © BACKUP WITHHOLDING - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. ❑ EXEMPT RECIPIENTS - I am an exempt recipient under the internal Revenue Service Regulations. SIGNATURE: I certify under penalties of perjury the statements checked in this section and that I am a U.S. citizen or other U.S. person (as defined in the nstructions). X — Signature Card -MT Hankers Systems TM wgliers Kluwer Financial Services 0 1992, 2009 ACCOUNT �.. —- NUMBER ACCOUNT OWNER(S) NAME & ADDRESS C005076 CITY OF KALISPELL KALISPELL MUNICIPAL COURT' BOND TRUSTPF PO BOX 1997 KALISPELL MT 59903-1997 35 FIRS'T' AVE E Revised Date:06/11/12 ADDING AND REMOVING SIGNERS ❑ NEW EXISTING TYPE OF © CHECKING ❑ SAVINGS ACCOUNT ❑ MONEY MARKET" ❑ CERTIFICATE OF DEPOSIT ❑ NOW ❑ This is your (check one): TOTALLY FREE 13USINES 0 Permanent ❑ Temporary account agreement. Number of signatures required for withdrawal I FACSIMILE SIGNATURE(S) ALLOWED? ❑ YES X. • SIGNATURE(S) - The undersigned certifies the accuracy of the information he(she has provided and acknowledges receipt of a completed copy of this form, The undersigned authorizes the financial institution to verify credit and employment history andfor have a credit reporting agency prepare a credit report on the undersigned, as individuals. The undersigned also acknowledge the receipt of a copy and agree to the terms of the following agreemenffs) andor disclosure(s): © Terms & Conditions ® Truth in Savings ® Funds Availability © Electronic Fund Transfers [_�g Privacy 0 Substitute Checks Common Features ❑ IX RICHARD G WILLS I. D. # (2); IX THELMA KEYS--NICOL I.D. # _ D.0.B. {s): IX NEIDI JOANN ULDRICHT I.D. # _ D.O.B. (4)• IX I.D. # D.O.S. AGENCY (POWER OF ATTORNEY) DESIGNATION #Optional): To Add Agency Designation To Account, Name One or More Agents: (Select One and Initial): ❑ Agency Designation Survives Disability or Incapacity of Fart€es ❑ Agency designation Terminates on btsability or Incapacity of Parties MPSC-LAZ-MT 10/1/2009 Page 1 of 1