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Resolution 5383 - AMENDS RESOLUTION 5094 - Bank Account SignatoriesRESOLUTION NO.5383 A RESOLUTION AMENDING RESOLUTION 5094, AUTHORIZING THE CITY MANAGER, FINANCE DIRECTOR, DEPUTY FINANCE DIRECTOR, AND CITY TREASURER TO EXECUTE CHECKS, DRAFTS OR OTHER ORDERS WITHDRAWING FUNDS FROM CITY ACCOUNTS WITH GLACIER BANK. BE 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 THIS 17TH DAY OF AUGUST, 2009. ATTEST: Theresa White City Clerk GLACIER BANK 202 MAIN STREET KALISPELL, MT 59901 (406) 756-4200 OWNERSHIP OF ACCOUNT - CONSUMER (Select One and Initial): ❑ 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 ❑ Multiple -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 -ON -DEATH BENEFICIARIES: 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: FINANCE COUNTY & STATE FLATHEAD MT OF ORGANIZATION: AUTHORIZATION DATED: 08/10/09 DATE OPENED 03/07/02 By ASHLIE HOLTZ INITIAL DEPOSIT $ ❑ CASH ❑ CHECK ❑ HOME TELEPHONE# (406) 758-7700 BUSINESS PHONE #, DRIVER'S LICENSE # E-MAIL EMPLOYER (406) 758-7700 MOTHER'S MAIDEN NAME Name and address of someone who will always know your location: BACKUP WITHHOLDING CERTIFICATIONS TIN: 81-6001281 © 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. person (including a U.S. resident alien). X (Date) ACCOUNT NUMBER 7 C005076 ACCOUNT OWNERS) NAME & ADDRESS CITY OF KALISPELL FINANCE DIRECTOR FINANCE DEPT ATTN: AMY ROBERTSON PO BOX 1997 KALISPELL MT 59903-1997 35 FIRST AVE E Revised Date:08/10/09 ADDING JANE AS SIGNER ❑ NEW EXISTING TYPE OF © CHECKING ❑ SAVINGS ACCOUNT ❑ MONEY MARKET ❑ CERTIFICATE OF DEPOSIT ❑ NOW ❑ This is your (check one): GLACIER BUSINESS CK Z Permanent ❑ Temporary account agreement. Number of signatures required for withdrawal 1 FACSIMILE SIGNATURE(S) ALLOWED? ❑ YES O NO IX 1 SIGNATURE(S) - The undersigned agree to the terms stated on every page of this form and acknowledge receipt of a completed copy. The undersigned further authorize the financial institution to verify credit and employment history and/or 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 disclosure(s): ❑ Deposit Account ® Funds Availability ® Truth in Savings Electronic Fund Transfers ® Privacy D� Substitute Checks El (1): IX I DEBRA J.DEIST I.D. # _ D.O.B. 06/04/54 (2): IX I AMY H ROBERTSON I.D. # D.O.B. 01/31/50 (3): Ix I RICHARD G WILLS I.D. # D.O.B. 12/18/63 (4): IX I JANE HOWINGTON I.D. # D.O.B. 12/30/57 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 Parties ❑ Agency Designation Terminates on Disability or Incapacity of Parties pelt® @1992 Bankers Systems, Inc., St. Cloud, MN Form MPSC-LAZ-MT 4/19/2004 (page 7 of 21