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Indemnity Bond on Lost Instrument <br /> NDCC 21-06-03 <br /> JACOBSON, KATIE, claims to be the owner and entitled to payment of a certain warrant <br /> number 270415 dated 4/16/2013 for the sum of$ 36.80, executed by Cass County <br /> Government but is unable to produce or surrender said instrument on account of its loss, <br /> destruction, or otherwise. <br /> I/We, JACOBSON, KATIE, as principal,jointly and severally undertake, promise and <br /> agree to pay any amount of loss that may be sustained by Cass County by reason of the <br /> issuance of a duplicate in the said sum of$ 36.80, or payment of such obligation. <br /> If there is more than one undersigned any liability hereunder and the representations <br /> and warranties made herein is joint and several and this agreement shall be binding upon <br /> the heirs, personal representatives, successors, and assigns of the undersigned and shall <br /> inure to the benefit of Cass County it's successors and assigns. <br /> In witness thereof, I/we have hereunto set our hands this day of 7aitf taXif, 20)q <br /> Signature/Title <br /> Ai <br /> AMINL1A M& <br /> an) (IhI) ,Sv &vi± <br /> STATE OF ND ) <br /> SS <br /> COUNTY OF (165,. ) <br /> On this p W�ay of J C1,A. , 20 )14, before me personally appeared a representative <br /> of JACOBSON, KATIE, known to me to be the person(s) described in and that executed the <br /> within instrument and severally acknowledge• o me that they executed the same. <br /> ANGELA L. ERNST <br /> Notar y Public <br /> State of c <br /> M Commission Ex■ir es A iii 1 <br /> 17,2019 N otary P d t is 4111. <br />