Form Dfr 2/2012 Ia - Vermont Surety Bond Form (Page 3 of 3) in pdf

Form Dfr 2/2012 Ia - Vermont Surety Bond Form Page 3

ACKNOWLEDGEMENT OF PARTNERSHIP

STATE OF _________________________)

COUNTY OF _______________________)

On this ____________day of __________________, 20_______, before me personally appeared

_______________________________, to me known to be a member of the firm who executed the foregoing

instrument, and she/he duly acknowledged to me that she/he executed the same as and for the act and deed of

said firm.

(NOTARIAL SEAL)

__________________________________________________

Notary Public,

__________________________________________________

County, ___________________________________________

My commission expires ______________________________

ACKNOWLEDGEMENT OF CORPORATION

STATE OF _________________________)

COUNTY OF _______________________)

On this __________ day of _________________, 20_______, before me personally came

___________________________________________________, and says that she/he is the

______________________________of _______________________________. Principal heretofore names; that

she/he executed the instrument for and in its behalf, by authority of its Board of Directors, and affixed its seal

thereto.

(

NOTARIAL SEAL)

_______________________________________________________________

Notary Public,

__________________________________________________

County, ___________________________________________

My commission expires ______________________________

NOTE: A true and correct copy of the applicable “Power of Attorney” must be attached hereto where the

Bond is subscribed to by an “Attorney in Fact”.

DFR 2/2012 IA

Form Dfr 2/2012 Ia - Vermont Surety Bond Form Page 3