Form Tc-763wt - Withholding Tax Surety Bond Page 2
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1
2INDIVIDUAL ACKNOWLEDGMENT OF PRINCIPAL
STATE OF UTAH
SS
COUNTY OF
__ ____ __ _ _ _ _ __ _ _ _ _ _
On this
_ __ __
day of
___ _ _ _ _ _ _ _ _
, in the year 20
_ _ _
, before me personally appeared
__ __ __ __ __ __ __ __ _______
, to me
known and known to me to be the person, and described in, and who executed the foregoing instrument, and acknowledgment to me that he executed the same.
(NOTARY SEAL)
__ _ __ _ __ _ __ _ _ __
Notary Public
LLP/PARTNERSHIP OR FIRM ACKNOWLEDGMENT OF PRINCIPAL
STATE OF UTAH
SS
COUNTY OF
__ ____ __ _ _ _ _ __ _ _ _ _ _
On this
_ __ __
day of
___ _ _ _ _ _ _ _ _
, in the year 20
_ _ _
, before me personally appeared
__ __ __ __ __ __ __ __ _______
, to me
known and known to me to be of the firm of
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ __ __ __ __ __ __ __ __ __ _
, described in, and who
executed the same as and for the act and deed of said firm.
(NOTARY SEAL)
_ _ __ _ __ _ __ _ __ _ _
Notary Public
CORPORATE ACKNOWLEDGEMENT OF PRINCIPAL
(TO BE COMPLETED BY CORPORATION WITH CORPORATE SEAL)
STATE OF UTAH
SS
COUNTY OF
__ ____ __ _ _ _ _ __ _ _ _ _ _
On this
_ __ __
day of
___ _ _ _ _ _ _ _ _
, in the year 20
_ _ _
, before me personally appeared
__ __ __ __ __ __ __ __ _______
, to me
known, who, being by me duly sworn, did depose and say: That he resides in
_ _ _ _ __ __ __ __ __ __ __ __ __ __ __ __ _____
, that he is the
_ __ _ _ _ __ ___ _____ _ _ _ _ _ _ _
of the
_ _ _ _ __ _ _ _ _ _ _ _ _ _
, the corporation described in and which executed the above instrument;
that he knew the seal of said corporation, and that he signed his name thereto by like order.
(CORPORATE SEAL)
(NOTARY SEAL)
__ _ __ _ __ _ __ _ _ __
Notary Public
CORPORATE ACKNOWLEDGEMENT OF PRINCIPAL/LLC
(TO BE COMPLETED BY LLC OR CORPORATION WITHOUT CORPORATE SEAL)
STATE OF UTAH
SS
COUNTY OF
__ ____ __ _ _ _ _ __ _ _ _ _ _
On this
_ __ __
day of
___ _ _ _ _ _ _ _ _
, in the year 20
_ _ _
, before me personally appeared
__ __ __ __ __ __ __ __ _______
, to me
known, who, being by me duly sworn, did depose and say: That he resides in
_ _ _ _ __ __ __ __ __ __ __ __ __ __ __ __ _____
, that he is the
_ __ _ _ _ __ ___ _____ _ _ _ _ _ _ _
of the
_ _ _ _ __ _ _ _ _ _ _ _ _ _
, the corporation which executed the above instrument and which is
described therein; that he signed the above mentioned instrument on behalf of said corporation; that he was authorized to do so.
(NOTARY SEAL)
_ _ __ _ __ _ __ _ __ _ _
Notary Public
AFFIDAVIT OF QUALIFICATION BY SURETY
STATE OF UTAH
SS
COUNTY OF
__ ____ __ _ _ _ _ __ _ _ _ _ _
_ __ _ _ _ ____ ____ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ __
being first duly sworn, on oath deposes and says that he is the
_ __ _ _ _ __ ___ _____ _ _ _ _ _ _ _ _ _ _ _
of said company, and that he is duly authorized to execute and deliver the foregoing obligations; that said
company is authorized to execute the same and has complied in all respects with the laws of Utah in reference to becoming sole surety upon bonds, undertakings
and obligations.
Subscribed and sworn to before me
_____
__ _______ __
_ __
this
day of
20
________ __ ___ _
_ _ __ _ __ _ __ _ __ _ _
My Commission expires:
(NOTARY SEAL)
Notary Public
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