Form U-Sb - Uniform Surety Bond Form - Securities Departmnt (Page 3 of 4) in pdf

Form U-Sb - Uniform Surety Bond Form - Securities Departmnt Page 3

FORM U-SB

PAGE 3 OF 4

WITNESS OUR SIGNATURES, this the ______ day of ___________________, 20 _________.

_________________________________________

PRINCIPAL

(Corporate seal,

_________________________________________

if applicable)

___________________________________________

SURETY

(Corporate seal,

_________________________________________

if applicable)

_________________________________________

COUNTER SIGNATURE OF

________________________________ RESIDENT

AGENT OF SURETY

ACKNOWLEDGMENT OF INDIVIDUAL

STATE OF ____________________________)

COUNTY OF __________________________)

On this ________ day of __________________________, 20 _______, before me

personally appeared ___________________________________________________________, to me

known to be the person described in and who executed the foregoing instrument, as Principal and

acknowledged to me that he executed the same as this free and deed.

(NOTARIAL SEAL)

____________________________________

Notary Public,

____________________________________

County, _____________________________

My commission expires _________________

Form U-Sb - Uniform Surety Bond Form - Securities Departmnt Page 3