Fill and Sign the Massachusetts Bond Form

Prepared by, recording requested by and return to: ----------------------Above this Line for Official Use Only---------------------Name: _________________ Company: __________________ Address: __________________ City: ___________________ State: ______ Zip: __________ Phone: __________________ Fax: ___________________ BOND FOR DISSOLUTION- INDIVIDUAL (Mass. Gen. Laws Ann. ch.254 §14) Know All Men By These Presents: That we, __________________________________ , as principal and _________________________________ duly organized to transact business as a surety within the Commonwealth of Massachusetts, as surety, are holden and stand firmly bound and obliged unto _________________________________ in the penal sum of ____________________ Dollars ($ _________________ ), to the payment of which we bind ourselves, our heirs, successors and assigns, jointly and severally by these presents. Whereas, under date of _________________ , the said obligee recorded a Notice of Contract in the registry of deeds, as Instrument # ______________ , in Book ____________ at Page ___________ upon premises more fully described in said Notice, and Whereas, the principal desires to dissolve said lien in accordance with the provisions of section fourteen of chapter two hundred and fifty-four of the General Laws. Now, therefore, the condition of this obligation is such that if the said principal shall pay to the said obligee all sums which shall be adjudged in favor of the said obligee in an action brought under the provisions of said section fourteen, this obligation shall be void, otherwise to remain in full force and effect. In witness whereof, the aforesaid principal and surety have executed this instrument under seal this _____ day of _______________ , 20 ______ . ________________________ ________________________ Principal Surety ________________________ ________________________ By By _____ ___________________ _____ ___________________ Type or Print Name Type or Print Name State of Massachusetts County _____________ On this _______ day of _________, 20 ___, before me the undersigned notary public, personally appeared ________________________________________ (name of document signer), proved to me through satisfactory evidence of identification, which were _________________________________, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he or she signed it voluntarily for its stated purpose. _____________________ Notary Public Print Name: ___________________ My commission expires: ____________________