CONTINENTAL WESTERN

INSURANCE COMPANY

GENERAL NOTARY PUBLIC

KNOW ALL MEN BY THESE PRESENTS:

THAT of the town of in the county of

and State of Nebraska, lately appointed General Notary Public within and for said State of Nebraska, as principal, and the CONTINENTAL WESTERN INSURANCE COMPANY, a corporation of Des Moines, Iowa, as surety, is held and firmly bound unto the State of Nebraska in the penal sum of FIFTEEN THOUSAND DOLLARS, good and lawful money of the United States, to be paid to the State of Nebraska, for which payment well and truly made, we bind ourselves, our heirs, executors and administrators, jointly and severally by these presents:

Sealed with our seals, and dated this day of______, 20_____.

Whereas, the above bounden has been appointed to the office of General Notary Public within and for said State of Nebraska, for a term of four years from effective date of commission.

Now the conditions of the above obligation are such that if the said principal shall faithfully and in all things perform all duties required of him by law as a General Notary Public within and for said State, during his continuance in office by virtue of said appointment, then the above obligation to be void, else to remain in full force.

sign
here
PRINCIPAL

CONTINENTAL WESTERN INSURANCE COMPANY

By:

NEBRASKA RESIDENT AGENT Attorney-in-Fact

* * * * * * * * * * * * * * * *

STATE OF NEBRASKA
County of / }. / ss.

“I, , do solemnly swear that I will support the Constitution of the United States and the constitution of the State of Nebraska, and that I will faithfully and impartially perform the duties of the office of General Notary Public according to law, and to the best of my ability. And I do further swear that I do not advocate, nor am I a member of any political party or organization that advocates the overthrow of the government of the United States or of this State by force or violence; and that during such time as I am in this position I will not advocate nor become a member of any political party or organization that advocates the overthrow of the government of the United States or of this State by force or violence. So help me God.”

sign
here
PRINCIPAL

personally appeared before me and is known by the undersigned to be the same person designated as principal in the foregoing bond and the identical person signing the oath of office of a general notary public.

Subscribed and sworn to before me this day of______, 20______.

Witness my hand and official seal at

, Nebraska. NOTARY PUBLIC

NOTE: The bond must be signed in two places by principal.

The Oath of Office must be notarized. SEAL

Principal’s name on the bond must conform with name on application.