Fill and Sign the Know All Men by These Presents that as Principal Whose Form

- 1 - SURETY BOND STATE OF LOUISIANA PARISH OF _______________ KNOW ALL MEN BY THESE PRESENTS, That _______________, as principal, whose business address is _______________, _______________, Louisiana _______________, and _______________, as sureties are firmly bound unto the Governor of Louisiana or his successor in office, in the full sum of _______________ and _____/100 ($ _______________) Dollars, which we promise to pay to him/her or his/her successor in office, for the faithful performanc e of which we bind ourselves firmly by the presents, and each of our heirs, executors and administration. THE CONDITION OF THIS OBLIGATION is such that if the above named p rincipal shall well and faithfully discharge and perform the duties incumbent on her as Notary Public o f _______________ Parish, then in such case the above obligation to be null and void; else to remain in full force and virtue. IN FAITH WHEREOF, We have signed these presents this _____ day of _______________ , 20_____ , at _______________, Louisiana. IN PRESENCE OF _______________________________ ____________________________ Signature of Witness Signature of Principal _______________________________ ____________________________ Signature of Witness Signature of Surety ************************************************************************************ (FOR PERSONAL SURETIES ONLY) STATE OF LOUISIANA PARISH OF _______________ Before Me, the undersigned authority, personally came and appeared, _______________, who, after being duly sworn, deposed and said that all of his debts and liabilities being paid, he is well and truly worth the sum for which he has hereinabove obligated himself. Sworn to and subscribed before me ____________________________ this _____ day of __________, Signature of Surety 20_____ . ______________________________ NOTARY PUBLIC ************************************************************************************ APPROVED NOTE: Public Officers file with Clerk of Court ___________________________ Notaries file with Secretary of State Clerk of Court, Recorder Received by Secretary of State - 2 - _________________________________________ _______________ Parish, Custodian of Notarial Records Date: _________________________