SSN Policy Manual

Indemnity Bond

, as surety, is bound to

as principal, and

oblr,qcc-

for the payment of which I bind myself, my

he sum of $

heirs, personal representatives, successors, and assigns,jointly and severally.

The Condition of this Bond is that

shall pay all costs and damages

oldigor

sustains in consequence of any claims arising out of the release

ohligcc

that

agreement herein.

.

Signed and Sealed on

nzo7ilth, titz~, jwxr

Bv:

as Attorney in Fact, as Surety

Public Domain-IB(O1)