Form Dts 22 - Surety Bond Affidavit And Acknowledgement Of Surety Page 2
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2AFFIDAVIT AND ACKNOWLEDGEMENT OF SURETY
DTS 22 (10/10/2013)
Page 2
All Surety Companies must complete the following or a reasonable facsimile.
COMMONWEALTH OR STATE OF _____________________________________________________________________
___________________________________ City or County (strike one) of ____________________________________ to-wit:
I, ______________________________________________________________________________ a notary public in and for
the _______________________________________________________________________ aforesaid, in the State aforesaid,
do certify that _________________________________________________________________________________ personally
appeared before me in my ____________________________________________________________________ aforesaid and
made oath that he/she is ___________________________________________________________________________ of the
_________________________________________________________ that he/she is duly authorized to execute the foregoing
bond by virtue of a certain power of attorney of said company, dated ______________________________ and recorded in the
Clerk’s Office of the __________________________________________ of _______________________________________,
in Deed Book No. ___________ page ___________, that said power of attorney has not been revoked, that the said company
is legally qualified to do business in Virginia, and that the said ___________________________________________________
thereupon, in the name and on behalf of the said company, acknowledged the following writing as its act and deed.
My term of office expires _______________________________________, 20 ______.
Given under my hand this ________________ day of ________________, 20 ______.
My six digit registration number is _________________________.
___________________________________________________________
(Notary Public Signature and Seal)
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