Taupa Member Application
Please Print this form and mail to Taupa P.O.Box 95 South Boston, MA 02127
Application will not be considered unless all blanks are completed

FOR THE TRANSACTION OF BUSINESS IN THE SAVINGS DEPARTMENT OF
TAUPA LITHUANIAN FCU, South Boston, MA     On signing this paper the depostitor(s) thereby agree(s) to the rules and regulations governing the Savings department of this Firm and to any alterations or amendments thereto that might be made by said Firm.
    "Under penalties of perjury, I certify that: (1) The number shown in this form is my correct taxpayeridenification number (or I am waiting for a number to be issued to me), and (2)I am not subject to backup withhldings because: (a) I am exempt from backup withholding, or (b) I have not been notified by the International Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and (3) I am a U.S. person (including a U.S. resident alien)."
Signature(s) S.S. Number
  
  
  
Address:
City: State: Zip:
Occupation: Date:

JOINT ACCOUUNT - PAYABLE TO EITHER OF SURVIVOR
    We agree and declare that all funds now or hereafter, deposited in this account are, and shall be our joint property and owned by us as joint tenants with right of survivorsip, and not as tenants in common; and upon the death of either of us any balance in said account shall become the absolute property of the survivor. The entire account or any part thereof may be withdrawn by or upon the order of us or the survivor.
    It is especially agreed that withdrawals of funds by the survivior shall be bindin upon us and upon our heirs, next of kin, legatees, assigns and personal representatives.
Signature:____________________________ Signature:____________________________