c. Lost Instrument Bonds - Laserfiche WebLink

Indemnity Bond on Lost Instrument NDCC 21-06-03 SCHULTZ, TINA, claims to be the owner and entitled to payment of a certain warrant number 270191 dated 3/27/2013 for the sum of$ 24.00, executed by Cass County Government but is unable to produce or surrender said instrument on account of its loss, destruction, or otherwise. I/We, SCHULTZ, TINA, as principal,jointly and severally undertake, promise and agree to pay any amount of loss that may be sustained by Cass County by reason of the issuance of a duplicate in the said sum of$ 24.00, or payment of such obligation. If there is more than one undersigned any liability hereunder and the representations and warranties made herein is joint and several and this agreement shall be binding upon the heirs, personal representatives, successors, and assigns of the undersigned and shall inure to the benefit of Cass County it's successors and assigns. i2 In witness thereof, I/we have hereunto set our hands this / a day of l a , 20.4 Signature/Title STATE OF N© ) ) SS COUNTY OF C-065 ) On this I' day of 19), before me personally appeared a representative of SCHULTZ,TINA, known to me to be the person(s) described in and that executed the within instrument and severally acknowledged to me that they executed the same. HEATHER KLEINWACHTER ► Notary Public Notary Public State of North Dakota 4 My Commission Expires Jan.21,_20164!