Form 1822-4 - Cash Bond (Assured Payment) Page 2
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1
2Signed, s e a l e d , and delivered t h i s
day of
, 20
.
I F INDIVIDUAL OR P A R T N E R S H I P , SIGN H E R E :
IN T H E PRESENCE OF TWO WITNESSES:
(Witness)
By
(Name)
(Address)
(Address)
(Witness)
(Name)
(Address)
(Address)
IF CORPORATION, SIGN HERE:
(Name)
(Address)
By
(Name)
( N a m e )
(Address)
( T i t l e )
T
U
S
O
A
HE
NITED
TATES
F
MERICA
Signed and Approved:
By
( N a m e )
( T i t l e )
CORPORATION CERTIFICATE
If Purchaser is a corporation, the following certificate shall be executed by the Secretary or Assistant Secretary of the
Corporation.
I,
, certify that I am t h e
Secretary of
the corporation named as Purchaser herein; that
, who signed t h i s
of s a i d corporation; that s a i d contract w a s duly signed for and in
contract, w a s then
behalf of s a i d corporation by authority of its governing body, and is within t h e scope of its corporate powers.
(Corporate Seal)
Title 18 U.S.C. Section 1001, makes i t a crime for any person knowingly and willfully to make to any department or a g e n c y of t h e
United S t a t e s any f a l s e , fictitious, or fraudulent s t a t e m e n t s or representations a s to any matter within i t s jurisdiction.
The Paperwork Reduction Act of 1980 (44 U.S.C. 3501 e t seq.) requires us to inform you that:
Information i s being collected to obtain surety information relevant to t h e operation of t h i s timber s a l e contract.
Information will be u s e d t o g u a r a n t e e performance under t h e terms of this timber s a l e contract.
R e s p o n s e to t h i s request i s mandatory (43 C F R 5 4 5 0 ) t o f u l f i l l the requirements of a timber s a l e contract.
(Form 1822-4, page 2)
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