Form Rt 133 - Motor Fuel Distributor Bond Form - Departament Of Safety Road Toll Bureau, State Of New Hampshire Page 2

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STATE OF NEW HAMPSHIRE
DEPARTMENT OF SAFETY
ROAD TOLL BUREAU
MOTOR FUEL DISTRIBUTOR BOND FORM
RELEASE AND DISCHARGE OF SURETY LIABILITY SHALL BE IN ACCORDANCE WITH RSA 260:37, II.
IN TESTIMONY WHEREOF, THE PRINCIPAL HAS HERE UNTO SET HIS HAND AND SEAL AND THE SURETY
HAS CAUSED THIS INSTRUMENT TO BE SIGNED BY______________________________AND ITS CORPORATE SEAL
TO BE HEREUNTO AFFIXED THE DAY AND YEAR FIRST ABOVE WRITTEN
WITNESS:
SIGNATURE
(SEAL)
TITLE
BY: ______________________________________________COMPANY
COUNTERSIGNED,
SIGNATURE
(SEAL)
NH LICENSED AGENT
TITLE
BY: __________________________
SIGNATURE
RT 133 (Rev. 05/04)

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