Required Information Form

Know Your Customer
Required Information Collection Form
Page 1 of 3
To help the United States government fight the funding of terrorism and prevent money laundering activities, U.S. Federal law requires all 
financial institutions to obtain, verify, and record information that identifies each person (individual, corporation, partnership, trust, estate, 
or any other entity recognized as a legal person) who opens an account. U.S. Bank will ask for the legal name, address, tax identification 
number, and other identifying information that will assist us in completing the review of your contract/application. We may also ask 
for copies of certified articles of incorporation, an unexpired government-issued business license, a partnership agreement, or other 
documents that indicate the existence and standing of the entity. U.S. Federal law also requires financial institutions to conduct ongoing 
customer due diligence, verify the identity of beneficial owners of certain legal entities, and comply with U.S. Economic Sanctions. U.S. Bank 
may require identification information on Customer, its Affiliates, Related Parties, or Cardholders, if applicable, to allow U.S. Bank to remain 
in compliance with U.S. Federal law or U.S. Bank policy. Customer agrees to promptly provide such identification information to U.S. Bank, 
and Customer shall cause its Affiliates, Related Parties or Cardholders, if applicable, to provide identification information to U.S. Bank .
How to complete this form:
Answer all questions completely and thoroughly, reviewing the requirements of each section. Missing information will cause delays 
in processing. Abbreviations or acronyms are not acceptable. Post Office Boxes or Personal Mailboxes are not acceptable, please 
provide physical address for any addresses provided. You must notify U.S. Bank if any information in the form changes.
Section A: Customer Information
• Provide the full legal name of the customer as it is captured on formation documents. This does not include Doing Business As (DBA) 
or Trade names.
Company Information 
Company Name:
Identification Number:  
• (TIN, EIN, SSN, ITIN)
Is the above Identification Number shared with another entity?
 Yes   No
If Yes, provide all entities that share the Identification Number:
Legal Physical Address: 
(Where the business is located. Do not provide a mailing address)
Does the company have Trade or Doing Business As (DBA) name(s)?
 Yes   No
If Yes, provide only the Trade or DBA(s) that are applicable to 
your relationship with U.S. Bank:
Provide the DBA address(es) if is different than the  
company address:
Section B: Exempt Entities – Do any of the below business types apply to your business? 
• Please select the business type that applies to the business captured in Section A. 
If the company is a subsidiary of a Public Body or Publicly Traded Entity and has its own financials, complete the entire form, supply 
formation documents and the most recent organization chart.
□ Is your business a U.S. Department or Agency, including Indian Tribal Government, or was it formed under in interstate compact 
between two or more states?
□ U.S. Political Subdivision (Local Government Entity)
□ Financial institution that is regulated by a Federal or State Regulator: 
□ Any entity established under an interstate compact, including Indian Tribal Governmental Entities
□ An entity that is listed on the New York, NYSE Market LLC, or NASDAQ stock exchanges – this only applies to U.S. operations
□ Subsidiary of a Publicly Traded parent listed on NYSE, NYSE MKT LLC, or NASDAQ stock exchanges*. This only applies to U.S. 
operations and U.S entities where equity of 51% or more is held by a U.S. listed entity. *Excludes subsidiaries and entities listed under 
NASDAQ Capital Market (Nasdaq-CM) Companies
 
Name of Exchange:  	
  Ticker Symbol:  
City of El Mirage
86-6000767
10000 N EL MIRAGE RD 
EL MIRAGE, AZ 85335
I
I
I

Section C: Standard Due Diligence Questions
1
What is the nature of your business? 
(What products or services do you supply?) 
• Include NAICS if known
2
Does your business operate in the hemp industry? 
(If yes supply USDA License, or State/Tribal Government License along 
with this form)
 Yes   No
3
What is the legal structure of your business? 
(e.g., Corporation, Limited Partnership/LLP, Not-for-Profit Organization, 
LLC, Single Member LLC, Partnership, Sole Proprietor, Government)
4
What is the company’s country of formation?
5
What is the country of primary business operations for the company?
6
Does the company provide any of the following services to your customers? If Yes, which service?
• check cashing services
 Yes   No
• issue or cash travelers checks or money orders
 Yes   No
• provide money transmission or foreign exchange services
 Yes   No
• offer prepaid cards
 Yes   No
7
What is the company’s estimated or projected annual  
revenue/budget (USD)? 
(If none, please indicate with $0. None and N/A are not allowed.)
$
Section D: Authorized Signer 
• One individual is required, additional individuals are optional. 
Full Legal Name 
Provide one of the following sets of items:
Date of Birth (mm/dd/yyyy), 
OR 
Physical Residential Address (preferred) OR Business Address 
OR 
SSN/ITIN/Foreign ID 
(A copy of the non-expired foreign ID is required along with this form)
1
 No middle name
2
 No middle name
Page 2 of 3
MUNICIPAL GOVERNMENT
I
GOVERNMENT
UNITED STATES OF AMERICA
UNITED STATES OF AMERICA
I
I
I
90,000,000
I
JENNIFER CRYSTAL DYCHES
10000 N EL MIRAGE RD 
EL MIRAGE, AZ 85335

Section E: Control of Public Funds (Government Entities Only)
• Applicable law requires U.S. Bank to retain information regarding the individual, full legal name, and title who has control over public 
funds, which in this case includes credit balances on the card accounts. Control of public funds includes possession of, as well as authority 
to establish, accounts for such funds in a bank and to make deposits, withdrawals, and disbursements or to direct these activities. 
• Individuals listed in Section D can also be listed in Section E if applicable 
What is the authority type over the public funds?
 Independent Authority (Requires action or consent of only one official custodian) 
- One individual is required to be listed below; additional individuals are 
optional)
 Dependent Authority (Requires action or consent of two or more official 
custodians.) 
- At least two individuals are required to be listed 
Full Legal Name 
(First, Middle, Last)
Title – acceptable titles include Chairman, CEO, CFO, City Manager, Comptroller, 
Director of Administration & Finance, Director of Fiscal Services, District 
Superintendent, Executive Director, Finance Director, General Manager, Governing 
Board President, Mayor, President, Superintendent, Treasurer
1
 No middle name
2
 No middle name
Section F: Certification by Authorized Signer
This section must be completed by an appropriate individual with the authorization of the Customer provided in Section A at the top of this 
form. e.g., the secretary or other officer, a member or manager of an LLC, partner of a partnership, business owner, Chief Executive Officer 
(CEO), controller, Chief Operating Officer (COO), Chief Financial Officer (CFO).
I, an Authorized Officer of the company name listed in Section A above, hereby attest that all information supplied on this form and/or any 
documentation supplied as requested in this form is true and accurate to the best of my knowledge.
Printed Full Legal Name 
 No middle name
Title:
Date:
E-mail Address
Signature:
©2023 U.S. Bank. All trademarks are the property of their respective owners. U.S. Bank Customer Confidential 
Know Your Customer: Required Information Collection Form 	
	
Page 3 of 3
08-0011-03-US (Rev. 03/23) CAT-18928336 
I
JENNIFER CRYSTAL DYCHES
CITY MANAGER
JENNIFER CRYSTAL DYCHES
CITY MANAGER
09/03/2025
CDYCHES@ELMIRAGEAZ.GOV
SIGN