Form Modes-4252 - Surety Bond (Financial Guarantee For Payment Of Contributions) Page 3
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3ACKNOWLEDGEMENT BY PRINCIPAL
INDIVIDUAL
Notary Public Embosser Seal
County (or City of St. Louis)
On This
State of
before
Missouri
me
Day of
20
Name of Notary (print or type)
A Notary Public in and for said state, personally
appeared
Name of Individual (print or type)
Known to me to be the person who executed the
within
Type of Document
and acknowledge to me that he/she executed the same for the purpose
therein stated
Notary Public Signature
My Commission Expires
Use Rubber
^
^
Stamp Here
PARTNERSHIP
Notary Public Embosser Seal
County (or City of St. Louis)
On This
State of
before
Missouri
me
Day of
20
Name of Notary (print or type)
A Notary Public in and for said state, personally
appeared
Name of Individual (print or type)
Known to me to be the person who executed the
within
Type of Document
and acknowledge to me that he/she executed the same for the purpose
therein stated
Notary Public Signature
My Commission Expires
Use Rubber
^
^
Stamp Here
CORPORATION
Notary Public Embosser Seal
County (or City of St. Louis)
On This
State of
before
Missouri
me
Day of
20
Name of Notary (print or type)
A Notary Public in and for said state, personally
appeared
Name of Individual (print or type)
Known to me to be the person who executed the
within
Type of Document
and acknowledge to me that he/she executed the same for the purpose
therein stated
Notary Public Signature
My Commission Expires
Use Rubber
^
^
Stamp Here
MODES-4252-3 (09-10) AI
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