Form Bnd-Sur-01.01 - Surety Bond Posted To Secure Performance Under Title 32 Page 2
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1
2AFFIDAVIT OF QUALIFICATION
(Must be completed by surety)
State of _________________
ss
Choose County
County of _______________
_________________ in the year _______ , before me personally appeared
Choose Month
On the ______________day of _
____________
_________________________________________________, being first duly sworn on oath deposes and says that (s)he is the
_____________________________, of said insurance company, and that (s)he is duly authorized to execute and deliver the
foregoing obligation; that said insurance company is authorized to execute the same and has complied in all respects with the laws of
Nevada in reference to becoming sole surety upon bonds, undertaking and obligations
Notary Public
Residing at
My commission expires
[Seal]
CORPORATE ACKNOWLEDGMENT
State of __________________
ss
Choose County
County of ________________
On the _______ day of____________ in the year _________, before me personally appeared ______________________________
Choose Month
to me known who, being by me duly sworn, did depose and say: That (s)he resides in _________________________________ that
(s)he is the _______________________ of _____________________________ the corporation which executed the instrument on
the reverse and which is described therein; that (s)he signed the instrument on behalf of the said corporation; that (s)he was
authorized to do so by Article ______________ of the Articles of Incorporation of the said corporation, and by order of the Board of
Directors of said corporation; and that his/her signature as it appears on the instrument is binding upon the corporation.
Notary Public
Residing at
My commission expires
[Seal]
SOLE OWNER, LLC, LLP OR PARTNERSHIP ACKNOWLEDGMENT
State of ____________________
ss
County of __________________
Choose Month
On the _______ day of____________ in the year _________, before me personally appeared ______________________________
to me known who, being by me duly sworn, did depose and say: That (s)he is _________________ of _______________________,
and that (s)he is duly authorized to execute on behalf of the said business the instrument on the reverse and which is described
therein.
Notary Public
Residing at
My commission expires
[Seal]
BND-SUR-01.01
Revised 9-16-14
Page 2
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