HomeMy WebLinkAboutResolution No. 815-23 Signer's on Checking AccountRESOLUTION NO. 815-23
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
ZEPHYRHILLS, PASCO COUNTY FLORIDA, AUTHORIZING THE
MAYOR, THE CITY MANAGER AND THE CITY CLERK TO SIGN
CHECKS, TO MAKE DEPOSITS AND WITHDRAWLS.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
ZEPHYRHILLS, FLORIDA:
Section 1: The City is required to designate authorized signers on its checking accounts. The
City Council designates the following as the authorized signers on the City's
checking accounts at Tmist Bank:
The Mayor
The City Manager
The City Clerk
Section 2: The City Council gives authority to William C. Poe, Jr, and Melonie Bahr Monson,
which are both required, to open and close Tmist bank account and adopt the
attached Truist Resolution for Deposit Account (Exhibit A).
Section 3: The City will require that two of the three above designated signatories to authorize
each check and adopt the attached Tmist Signature Card (Exhibit B) for each Truist
bank account.
Section 4: As of the date noted herein this Resolution, the following are the named persons
and their signatures holding the office designated after their names, to wit:
s-<<«^/
Melonie B Monson., Mayor
-c.
William C. Poe, Jr., City Manager
^ Lori L. Hillman, City Clerk
Section 5: All Ordinances or parts of Ordinances, Resolutions or parts of Resolutions in
conflict herewith be and the same are hereby repealed to the extent of such conflict.
SectipnyS:^^ This resolution shall take effect upon its adoption by City Council
'ms^
;.'^i^<ft)i-egomg-^iolutionNo. 815-23 was read and passed in an open and regular meeting of the
^^ity Council-ofd^ityofZephyrhills, Florida, on this 8th day of May, 2023.
'!;;.;SS /
^Attes
t»
^ .'r:.,|sf" -. ' '" . .^
> ^ ori L.-Hi.ll]^, City Clerkp _. ?* ^*- ...'"??'/.^. .
'°.^^w/
L ce . Smith, Council President
'\:1^.-
Me nie Bahr Monson, Mayor
IM^C^
Approved as to legal form and legal content
for the sole reliance of the City ofZephyrhills
/Ci'^ /<^
Matthew E. Maggard, Ci Attorney
Page 445 of 483
CITY OF ZEPHYRHILLS
Name of Entity
m Corporation
Q Unincorporated Association
D Limited Liability Company
Exhibt A
TRUIST
RESOLUTION FOR DEPOSIT ACCOUNT
596000455
F5d Government Entity
D General Partnership
\~] Limited Partnership
TIN
D Sole Proprietorship
II Non-Profit Corporation
D Other
The undersigned, acting in the capacity as corporate secretary or custodian of records for the above-named Entity, organized and
existing under the laws of FLO-RIDA , represents to Truist Bank ("Bank")
that I have reviewed the governing documents and relevant records of the Entity and certify that resolutions or requirements similar to those
below are adopted by and, are not inconsistent with the governing documents or records of the Entity, and that such resolutions or
requirements are current and have not been amended or rescinded.
I. That the Bank is designated as a depository institution for the Entity and that by execution and delivery of this Resolution for
Deposit Account the Entity will be bound by the Bank's deposit account agreement now existing or as may be amended. Any officer, agent
or employee of the Entity is authorized to endorse for deposit any check, drafts or other instruments payable to the Entity, which endorsement
may be in writing, by stamp or otherwise, with or without signature of the person so endorsing.
II. That any one individual named below (a "Designated Representative") is authorized to open accounts on behalf of the Entity, to
close any account or obtain information on any account. Any one Designated Representative may appoint others (an "Authorized Signer") to
conduct transactions on an account by authorizing them to sign their name to the signature card.
Designated Representativ (Signature)
^^
^Sf ^r
Vyyyj yy^^^
Printed Name
Melonie Bahr Monson
William C. Poe, Jr.
Lori L. Hillman
Title
Mayor
City Manager
City Clerk
III. That the Bank is authorized upon the signature of any one signer on a signature card to honor, pay and charge the account of the
Entity, all checks, drafts, or other orders for payment, withdrawal or transfer of money for whatever purpose and to whomever payable.
IV. That any one Designated Representative may appoint, remove or replace an Authorized Signer, enter into a night depository
agreement, enter into an agreement for cash management services, lease a safe deposit box, enter into an agreement for deposit access
devices, enter into an agreement for credit cards, enter into an agreement relating to foreign exchange and obtain online foreign exchange
services related thereto, or enter into any other agreements regarding an account of the Entity
FOR BANK USE ONLY
Prepared By
Center
ESTHER TORRES
85513471
4/11/2023
Date
Bank No. 502 State FL
Forward to:
Centralized Document Scanning Operations
M/C 100-99-15-1f
8010 (2110)
V. That any prior resolutions or requirements have been revoked or are no longer binding, and that this Resolution for Deposit
Account applies to all accounts at the Bank and will remain in full force and effect until rescinded, replaced or modified in writing in a form
acceptable to the Bank and after the Bank has had a reasonable time to act on such change.
VI. That any transaction by an officer, employee or agent of the Entity prior to the delivery of this Resolution for Deposit Account
is hereby ratified and approved.
May 8, 2023DATED:
SIGNATURE
Melonie Bahr Monson
PRINTED NAME
!mS6-^-
8010(2110)
TRUIST SIGNATURE CARD ADDENDUM (FLORIDA)
This addendum is made part of the signature card attached herewith for the sole purpose of permitting additional signers thereto.
ACCOUNT NUMBER OWNERSHIP DESIGNATION
0569000000108 COUNTY
Opened/Updated By
ACCOUNT OPENING DATE REVISED CARD DATE
4/11/2023
Approved By Branch Location
IDENTIFICATION
Type of I D
Second Type of ID
Employer
Address as listed on ID
Type of I D
Second Type of ID
Employer
Address as listed on ID
Type of I D
Second Type of ID
Employer
Address as listed on ID
Issued By _ ID Number
Issued By ID Number
Cell Phone Number (
Expiration Date Date of Birth
Expiration Date
Home Phone Number (
Work Phone Number (
Issued By_ ID Number
Issued By ID Number
IDENTIFICATION
Expiration Date Date of Birth
Expiration Date
Cell Phone Number (_) Home Phone Number (_)
Work Phone Number (
IDENTIFICATION Date of Birth
Issued By_ ID Number Expiration Date
Issued By ID Number Expiration Date
Cell Phone Number (_) Home Phone Number (_)
Work Phone Number (.
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EI N:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
SSN/EIN:Relationship:
ID:
BUSINESS ACCOUNTS
By my/our signature below, 1/We certify that: (1) l/We have received the "Commercial Bank Services Agreement" and the "Business Deposit
Accounts Fee Schedule" and on behalf of the Depositor agree to the terms of each document; and (2) 1/We give consent to verify my/our credit
references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications In the
box above which are required to avoid backup wHhholding.
TIN of Signer
TIN of Signer
William C. Poe, Jr.
Printed Name
Lori L, Hillman
Printed Name
.^f
5/8/2023
DATE
5/8/2023
DATE
TIN of Signer Printed Name DATE
8006XX_BB (2110)
Exhibit B
TRUIST SIGNATURE CARD (FLORIDA)
NAME AND ADDRESS OF DEPOSITOR
CITYOFZEPHYRHILLS
5335 8TH STREET
ZEPHYRHILLS, FL 33542
ACCOUNT NUMBER
0569000000108
Opened/Updated By
OWNERSHIP DESIGNATION
COUNTS
ACCOUNT OPENING DATE REVISED CARD DATE
/11/2023
Approved By E.TORRES/D43740
Branch Location
Type of I D
Second Type of ID
Issued By
Issued By
ID Number
ID Number
IDENTIFICATION
Expiration Date
Expiration Date
Employer
Address as listed on ID
Cell Phone Number (Home Phone Number (
Work Phone Number (
IDENTIFICATION
Type of ID
Second Type of I D
Employer
Address as listed on ID
Issued By
Issued By
ID Number
ID Number
Expiration Date Date of Birth
Expiration Date
Cell Phone Number (_) Home Phone Number (
Work Phone Number (
Check Appropriate Box for Depositor
[__](ndiwdua//SotePropnetor/smg/e-mem<)erLLC [~] C Corporation Q SCoiporatfon Q Partnership || TrusVEstate \ | Limited Liability Company
Enter the tax classiricatlon (C=C corporation, S = S coiporatlon, P = Partnership) \ ]
No(e; Check (he apprprlafe box in /ine above for (he lax classificatton of the slngle-member owner. Do not c/ieclt LLC it the LLC Is classified as a slngle-member LLC that Is
cfisregarded from the owner unless the owner of the LLC Is another LLC that Is not disregarded from the owner lor U.S. federal lax purposes. Otherwise, a single-member LLC
that Is disregarded from the owner should check the appropriate box for the lax classification of tts owner.
Exemptions: See Instructions Exempt Payee code (if any) \ | Exemption from FATCA reporting code (if any) \ | N/A (applies to accounts maintained outside the U.S.)
Certification - Under penalities of perjury, I, as authorized agent of the Depositor certify that:
1. The Depositor's correct taxpayer Identification number is printed below (or the Depositor is waiting for a number to be issued), and
2. The Depositor Is not subject to backup withholding because: (a) the Depositor is exempt from backup withholding, or (b) the Depositor has not been notified by
the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IPS has notified the
Depositor that it is no longer subject to backup withholding, and
3. The Depositor is a U.S. citizen or other U.S. person (defined in the Instructions): and
4. The FA TCA codes(s) entered on this form (if any) indicating that the Depositor is exempt from FA TCA reporting Is correct.
Certification Instructions. You must cross out item 2 above if the Depositor has been notified by the IRS that the Depositor is currently subject to back withholding
because the Depositor has failed to report all interest and dividends on the Depositor's tax return.
Form W-9 Instructions. Instmctions to the Form W-9, induding definitions, are available upon request.
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EIN:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
BUSINESS ACC NTS
By my/our signature below, 1/We certify that: (1) l/We have received the "Commercial Bank Services Agreement" and the "Business Deposit Accounts Fee Schedule"
and on behalf of the Depositor agree to the terms of each document; and (2) 1/We give consent to verify my/our credit references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications in the
box above which are required to avoid backup withholding.
596000455
TIN of Depositor
CITi' OF ZEPHYRHILLS
Printed Name of Depositor
^S^s-
elomP P^p fl^n^}^Toi/8/2023
Printed
'Name/Title:Melonie Bahr Monson, Mayor DATE
TIN of Signer
Melonie Bahr Monson
Printed Name of Signer
5/8/2023
DATE
8005XX_BB (2110)
TRUIST SIGNATURE CARD (FLORIDA)
NAME AND ADDRESS OF DEPOSITOR
CITY OF ZEPHYRHILLS
5335 8TH STREET
ZEPHYRHILLS, FL 33542
ACCOUNT NUMBER
0569000000124
Opened/Updated By
OWNERSHIP DESIGNATION
COUNTY
ACCOUNT OPENING DATE REVISED CARD DATE
/11/2023
App.ve. s. E.TORRES/D43740 ^^^
Type of ID
Second Type of ID
Issued By
Issued By ID Number
IDENTIFICATION
Expiration Date Date of Birth
Expiration Date
Employer
Address as listed on ID
Cell Phone Number (_)Home Phone Number (_)
Work Phone Number (
IDENTIFICATION
Type of ID Issued By _ ID Number
Second Type of ID Issued By ID Number
Employer
Address as listed on ID
Exoiration Date Date of Birth
Expiration Date
Cell Phone Number (_) Home Phone Number ( _)
Work Phone Number (
Check Appropriate Box for Depositor
[I Individual I Sole Proprietor / single-member LLC \ | C Corporation || S Corporation || Partnership |] Trust/Estate \ | Limited Liability Company
Enter (he (ax classification <C = C corporation, S = S corporation, P = Partnership)
Note: Check the apprprlate box In line above for the tax classltlcaflon of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is
disregarded from the owner unless the owner of the LLC Is another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a smgle-member LLC
ffiaf is disregarded from (fie owner should check the appropriate box for the tax classMcation of Its owner.
g Other (See Instructions.) COU NTY
Exemptions: See Instructions Exempt Payee code (If any) \ \ Exemption from FA TCA reporting code (if any) \ ~~ \ N/A (applies to accounts maintained outside the U.S.)
Certification - Under penalities of perjury, I, as authorized agent of the Depositor certify that:
1. The Depositor's correct taxpayer Identification number is printed below (or the Depositor is waiting for a number to be issued), and
2. The Depositor is not subject to backup withholding because: (a) the Depositor is exempt from backup withholding, or (b) the Depositor has not been notified by
the Internal Revenue Service (IPS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified the
Depositor that it is no longer subject to backup withholding, and
3. The Depositor is a U.S. citizen or other U.S. person (defined in the instructions); and
4. The FA TCA codes(s) entered on this form (if any) indicating that the Depositor is exempt from FATCA reporting is correct.
Certification Instructions. You must cross out item 2 above if the Depositor has been notified by the IPS that the Depositor is currently subject to back withholding
because the Depositor has failed to report all Interest and dividends on the Depositor's tax return.
Form W-9 Instructions. Instructions to the Form W-9. includina definitions. are available unon reauest.
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EIN:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship;
BUSINESS ACCOUNT
By my/our signature below, 1/We certify that: (1) l/We have received the "Commercial Bank Services Agreement" and the "Business Deposit Accounts Fee Schedule"
and on behalf of the Depositor agree to the terms of each document; and (2) 1/We give consent to verify my/our credit references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications in the
box above which are required to avoid backup withholding.
596000455
TIN of Depositor
TIN of Signer
CITYOFZEPHYRHILLS
Printed Name of Depositor
Melonie Bahr Monson
Printed Name of Signer
^^ki <A^ <)^tSA-~
^n\e, ^ahrl^n^^. ^^
PNTmeed/Titie: Melonie Bahr Monson, Mayor
..^A^>^
5/8/2023
DATE
5/8/2023
DATE
8005XX_BB (2110)
TRUIST SIGNATURE CARD ADDENDUM (FLORIDA)
This addendum is made part of the signature card attached herewith for the sole purpose of permitting additional signers thereto.
ACCOUNT NUMBER
0569000000124
Opened/Updated By
OWNERSHIP DESIGNATION
COUNTY
Approved By
ACCOUNT OPENING DATE REVISED CARD DATE
4/11/2023
Branch Location
Type of ID
Second Type of ID
Employer
Address as listed on ID
Issued By _ ID Number
Issued By ID Number
IDENTIFICATION
Expiration Date Date of Birth
Expiration Date
Cell Phone Number (_) Home Phone Number ( _)
Work Phone Number (_)
Type of ID
Second Type of ID
Employer
Address as listed on ID
Issued By_ ID Number
Issued By ID Number
IDENTIFICATION
Expiration Date Date of Birth
Expiration Date
Cell PhoneNumbar (_) Home Phone Number (_)
Work Phone Number (_)
Type of ID
Second Type of ID
Employer
Address as listed on ID
Issued By_ ID Number
Issued By iD Number
IDENTIFICATION Date °f Birth
Expiration Date
Expiration Date
Cell Phone Number (_) Home Phone Number ( _)
Work Phone Number (_)
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EIN:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
SSN/EIN:Relationship:
ID:
BUSINES A OUNTS
By my/our signature below, 1/We certify that: (1) l/We have received the "Commercial Bank Services Agreement" and the "Business Deposit
Accounts Fee Schedule" and on behalf of the Depositor agree to the terms of each document; and (2) 1/We give consent to verify my/our credit
references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications in the
box above which are required to avoid backup withholding.
TIN of Signer
TIN of Signer
William C. Poe, Jr.
Printed Name
Lori L. Hillman
Printed Name
L^fr
z^ ^.
5/8/2023
DATE
5/8/2023
DATE
TIN of Signer Printed Name DATE
8006XX_BB(2110)
TRUIST SIGNATURE CARD (FLORIDA)
NAME AND ADDRESS OF DEPOSITOR
CITY OF ZEPHYRHILLS
5335 8TH STREET
ZEPHYRH ILLS, FL 33542
ACCOUNT NUMBER
0569000000124
Opened/Updated By
OWNERSHIP DESIGNATION
COUNTY
ACCOUNT OPENING DATE REVISED CARD DATE
/11/2023
Approved By E.TORRES/D43740
Branch Location
Type of ID
Second Type of ID
Issued By_ ID Number
Issued By ID Number
IDENTIFICATION
Expiration Date
Expiration Date
Employer
Address as listed on ID
Cell Phone Number (Home Phone Number (_)
Work Phone Numbsr (_)
IDENTIFICATION
Type of ID
Second Type of ID
Employer
Address as listed on ID
Issued By _ ID Number
Issued By ID Number
Expiration Date Date of Birth
Expiration Date
Cell Phons Number (_) Home Phone Number ( _)
Work Phone Number ( _ )
Check Appropriate Box for Depositor
Individual/Sole Proprietor/single-memberLLC Q C Corporation Q SCorporafton ^^Partnership [-] rrus(/Es(ate || Limited Liability Company
Enter (he lax classification (C=C corporation, S s S corporation, P = Partnership) ||
Note: Check the apprprlaie box In line above for the tax c/assiffcafaon of the slngle-member owner. Do not check LLC if the LLC Is classified as a single-member LLC that is
disregarded from the owner unless the owner of the LLC Is another LLC that is not disregarded from the owner for U.S. federal lax purposes. Otherwise, a single-member LLC
that is disregarded from the owner should check the appropriate box tor the tax classification of Its owner.
[.] Other (See Instructions.) COUNTY
Exemptions: See Instructions Exempt Payee code (If any) Q Exemption from FATCA reporting code (If any) \ ~~ ] N/A (applies to accounts maintained outside the U.S.)
Certification - Under penalities of perjury, I, as authorized agent of the Depositor certify that:
1. The Depositor's correct taxpayer identification number is printed below (or the Depositor is waiting for a number to be issued), and
2. The Depositor is not subject to backup withholding because: (a) the Depositor is exempt from backup withholding, or (b) the Depositor has not been notified by
the Internal Revenue Service (IPS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified the
Depositor that it is no longer subject to backup withholding, and
3. The Depositor Is a U.S. citizen or other U.S. person (defined in the instructions); and
4. The F/> TC/t codesCs; entered on this form (if any) indicating that the Depositor is exempt from FA TCA reporting is correct
CertHJcation Instructions. You must cross out item 2 above if the Depositor has been notified by the IRS that the Depositor Is currently subject to back withholding
because the Depositor has failed to report all Interest and dividends on (he Depositor's tax return.
Form W-9 Instructions. Instructions to the Form W-9, including definitions, are available upon request.
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EIN:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
BUSINESS AC NTS
By my/our signature below, IWe certify that: (1) l/We have received the "Commercial Bank Services Agreement" and the "Business Deposit Accounts Fee Schedule"
and on behalf of the Depositor agree to the terms of each document; and (2) Ifl/Ve give consent to verify my/our credit references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications in the
box above which are required to avoid backup withholding.
596000455
TIN of Depositor
CITY OF ZEPHYRHILLS
Printed Name of Depositor Print
.Name/Title:
f^- 5/8/2023
Melonie Bahr Monson, Mayor
TIN of Signer
Melonie Bahr Monson
Printed Name of Signer
5/8/2023
DATE
8005XX_BB (2no)
TRUIST SIGNATURE CARD ADDENDUM (FLORIDA)
This addendum is made part of the signature card attached herewith for the sole purpose of permitting additional signers thereto.
ACCOUNT NUMBER
0569000000124
Opened/Updated By
OWNERSHIP DESIGNATION
COUNTY
Approved By
ACCOUNT OPENING DATE REVISED CARD DATE
4/11/2023
Branch Location
IDENTIFICATION
Type of ID
Second Type of ID
Employer
Addresses listed on ID
Issued By_ ID Number
Issued By ID Number
Cell Phone Number (
Expiration Date Date of Birth
Expiration Date
Home Phone Number (_)
Work Phone Number (
Type of ID
Second Type of )D
Employer
Address as listed on ID
Issued By_ ID Number
Issued By ID Number
IDENTIFICATION
Expiration Date Date of Birth
Expiration Date
Cell Phone Number (__) Home Phone Number (_}
Work Phone Number (_)
Type of ID
Second Type of ID
Employer
Address as listed on ID
Issued By_ ID Number
Issued By ID Number
IDENTIFICATION Date of Birth
Expiration Date
Expiration Date
Cell Phone Number (__^ ) Home Phone Number (^_ )
Work Phone Number (.
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EIN:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
SSN/EIN:Relationship:
ID:
BUSINESS ACCOUNTS
By my/our signature below, 1/We certify that: (1) 1/We have received the "Commercial Bank Services Agreement" and the "Business Deposit
Accounts Fee Schedule" and on behalf of the Depositor agree to the terms of each document; and (2) 1/We give consent to verify my/our credit
references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications in the
box above which are required to avoid backup withholding.
TIN of Signer
William C. Poe, Jr.
Printed Name
^Sr.5/8/2023
DATE
TIN of Signer
Lori L. Hillman
Printed Name
5/8/2023
DATE
TIN of Signer Printed Name DATE
8006XX_BB (2110)
TRUIST SIGNATURE CARD (FLORIDA)
NAME AND ADDRESS OF DEPOSITOR
CITY OF ZEPHYRHILLS
5335 8TH STREET
ZEPHYRHILLS, FL 33542
ACCOUNT NUMBER
0569000000124
Opened/Updated By
OWNERSHIP DESIGNATION
COUNTY
ACCOUNT OPENING DATE REVISED CARD DATE
/11/2023
App^e, E.TORRES/D43740 ^^^
Type of ID
Second Type of ID
Issued By_ ID Number
Issued By ID Number
IDENTIFICATION
Expiration Date
Expiration Date
Employer
Address as listed on ID
Cell Phone Number (_)
IDENTIFICATION
Home Phone Number (_)
Work Phone Number (_)
Type of ID Issued By_ ID Number
Second Type of ID Issued By ID Number
Employer
Address as listed on ID
Expiration Date Date of Birth
Expiration Date
Cell Phone Number (___ ) Home Phone Number (_)
Work Phone Number (_)
Check Appropriate Box for Depositor
Q;nd;wdua//So/ePropr/etor/singfe-memberLLC Q C Corporation [-] S Corporation Q Partnership ^~^Trust/Estate \ | Limited Liability Company
Enter the tax classWcatlon (C=C corporation ,S=S corporation, P s Partnership)
Note: Check the apprprlale box In line above for the tax classification of the single-member owner. Do not check LLC If the LLC Is classified as a single-member LLC that is
disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC
that Is disregarded from Ihe owner should check the appropriate box for the tax classification of its owner.
'I Other(See Instructions.) COU NTY
Exemptions: See Instructions Exempt Payee code (if any) \ \ Exemption from FA TCA reporting code (If any) \ ~~ ]N/A (applies to accounts maintained outside the U.S.)
Certification - Under penalifies of perjury, I, as authorized agent of the Depositor certify that:
1. The Depositor's correct taxpayer Identification number is printed below (or the Depositor is waiting for a number to be issued), and
2. The Depositor is not subject to backup withholding because: (a) the Depositor is exempt from backup withholding, or (b) the Depositor has not been notified by
the Internal Revenue Service (IPS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified the
Depositor that it is no longer subject to backup withholding, and
3. The Depositor is a U.S. citizen or other U.S. person (defined in the instructions); and
4. The FA TCA codes(s) entered on this form (if any) indicating that the Depositor is exempt from FA TCA reporting is correct.
CerliTication Instructions. You must cross out item 2 above if the Depositor has been notified by the IPS that the Depositor is currently subject to back withholding
because (fie Depositor has failed to report all interest and dividends on the Depositor's tax return.
Form W-9 Instructions. Instructions to the Form W-9. including definitions. are available uoon reauest.
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EIN:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
BUSINESS ACCO NT
By my/our signature below, 1/We certify that: (1) IWe have received the "Commercial Bank Services Agreement" and the "Business Deposit Accounts Fee Schedule"
and on behalf of the Depositor agree to the terms of each document; and (2) 1/We give consent to verify my/our credit references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications in the
box above which are required to avoid backup withholding.
596000455
TIN of Depositor
CITYOFZEPHYRHILLS
Printed Name of Depositor
^5(j^-5/8/2023
Prin
'Name/Title:Melonie Bahr Monson, Mayor DATE
TIN of Signer
Melonie Bahr Monson
Printed Name of Signer
5/8/2023
DATE
8005XX_BB(2110)
TRUIST SIGNATURE CARD ADDENDUM (FLORIDA)
This addendum is made part of the signature card attached herewith for the sole purpose of permitting additional signers thereto.
ACCOUNT NUMBER
0569000000124
Opened/Updated By
OWNERSHIP DESIGNATION
COUNTY
Approved By
ACCOUNT OPENING DATE REVISED CARD DATE
4/11/2023
Branch Location
Type of ID
Second Type of ID
Employer
Address as listed on ID
IDENTIFICATION
Issued By_ ID Number
Issued By ID Number
Expiration Date Date of Birth
Cell Phone Number (.
Expiration Date
Home Phone Number (_)
Work Phone Number (_)
Type of ID
Second Type of ID
Employer
Address as listed on ID
Issued By _ ID Number
Issued By ID Number
IDENTIFICATION
Expiration Date Date of Birth
Expiration Date
Cell Phone Number (_) Home Phone Number (^ )
Work Phone Number (_)
Type of ID
Second Type of ID
Employer
Address as listed on ID
Issued By _ ID Number
Issued By ID Number
IDENTIFICATION Date °f Birth
Expiration Date
Expiration Date
Cell Phone Number (_) Home Phone Number (_ )
Work Phone Number (_)
Complete as applicable - only one beneficiary permitted if an entity.
Name of Beneficiary: SSN/EIN:
Address of Beneficiary:
ID:
Relationship:
Name of Beneficiary:
Address of Beneficiary:
ID:
SSN/EIN:Relationship:
Name of Beneficiary:
Address of Beneficiary:
SSN/EIN:Relationship:
ID:
BUSINESS ACCOUNTS
By my/our signature below, 1/We certify that: (1) l/We have received the "Commercial Bank Services Agreement" and the "Business Deposit
Accounts Fee Schedule" and on behalf of the Depositor agree to the terms of each document; and (2) 1/We give consent to verify my/our credit
references.
Please sign beside the Printed Name(s) only. If signature line does not have a Printed Name, then a signature is not required on that line.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications in the
box above which are required to avoid backup withholding.
TIN of Signer
William C. Poe, Jr.
Printed Name
^/5/8/2023
DATE
TIN of Signer
Lori L. Hillman
Printed Name
^5/8/2023
DATE
TIN of Signer Printed Name DATE
8006XX_BB (2110)