Uniform Surety Bond - South Dakota Department Of Revenue & Regulation - 2008 Page 2

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Signed and Sealed this
day of
, 20
.
INDIVIDUAL PRINCIPAL
By_____________________________________________
Typed Name__________________________________
(Affix Seal if available)
PARTNERSHIP OR CORPORATE PRINCIPAL
By_____________________________________________
Typed Name___________________________________
Title____________________________________________
Business Name_________________________________
(Affix Corporate Seal if available)
Address______________________________________
OTHER ENTITIES (L.L.C. & L.L.P) PRINCIPAL
By______________________________________________
Typed Name___________________________________
Title_____________________________________________
Business Name_________________________________
(Affix Seal if available)
Address______________________________________
ACKNOWLEDGMENT OF PRINCIPAL
(Individual)
State of ______________________)
) ss
County of_____________________)
On this_______day of____________________, 20_____, before me personally appeared __________________________,
known to me to be the individual described in and who executed the foregoing instrument and acknowledged to me that he
executed the same.
___________________________________
Notary Public
My commission expires the _______day of ____________________, 20_____.
ACKNOWLEDGMENT OF PRINCIPAL
(Partnership)
State of_______________________)
) ss
County of_____________________)
On this_______day of____________________, 20_____, before me personally appeared__________________________,
who acknowledged himself to be one of the partners of ____________________________________, a partnership, and that he, as
such partner, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name
of the partnership by himself as a partner.
___________________________________
Notary Public
My commission expires the _______day of ____________________, 20_____.

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