Improvement Damage Bond For Geophysical Permits Bond Form - 2009 Page 2
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2ACKNOWLEDGMENT FORM FOR NATURAL PERSONS:
STATE OF _______________________________)
) ss.
COUNTY OF _____________________________)
On this ______ day of ______________, 20_____, before me personally appeared________________________________________
to me known to be the person(s) described in and who executed the same as his (their) free act and deed.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on the day and year in this certificate first above written.
_____________________
_______________________________________
__________________________________
My Commission Expires
Notary Public name
Notary signature
(Notary seal)
ACKNOWLEDGMENT FORM FOR CORPORATION:
STATE OF ________________________________)
) ss.
COUNTY OF ______________________________)
On this _______day of ______________, 20_______, before me personally appeared _____________________________________,
to me personally known, who, being by me duly sworn, did say that he is _____________________________________________ of
_____________________________________________ and that this instrument was signed and sealed on behalf of said corporation
by authority of its board of directors, and acknowledged said instrument to be the free act and deed of said corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on the day and year in this certificate first above written.
_____________________
__________________________________
____________________________________
My Commission Expires
Notary Public name
Notary signature
(Notary seal)
ACKNOWLEDGMENT FORM FOR CORPORATE SURETY:
STATE OF ________________________________)
) ss.
COUNTY OF ______________________________)
On this _______day of ______________, 20_______, before me personally appeared _____________________________________
to me personally known, who, being by me duly sworn, did say that he is ____________________________________________ of
_________________________________________ and that this instrument was signed and sealed on behalf of said corporation by
authority of its board of directors, and acknowledged said instrument to be the free act and deed of said corporation.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on the day and year in this certificate first above written.
_____________________
______________________________________
_________________________________
My Commission Expires
Notary Public name
Notary signature
(Notary seal)
(Note: Corporate surety attach power of attorney.)
APPROVED
this ________day of _______________, 20______.
_________________________________________
COMMISSIONER OF PUBLIC LANDS
NOTE: File with: Commissioner of Public Lands; New Mexico State Land Office OGMD ;
P.O. Box 1148; Santa Fe, New Mexico 87504-1148
BEFORE any development or operations are commenced.
Revised September 2009
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