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• 4 <br /> Indemnity Bond on Lost Instrument <br /> NDCC 21-06-03 <br /> GATE CITY BANK, claims to be the owner and entitled to payment of a certain warrant <br /> number 275664 dated 12/30/2013 for the sum of$ 10.00, 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, GATE CITY BANK, 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$ 10.00, 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 P L , 20/ <br /> Signature/Title <br /> Sr ac, <br /> STATE OF /VP <br /> ) SS <br /> COUNTY OF Lac S ) <br /> 0 ` � <br /> On this I U day of Afri , 20 (`1 , before me personally appeared a representative <br /> of GATE CITY BANK, known to me to be the person(s) described in and that executed the <br /> within instrument and severally acknowledged to me that they executed the same. <br /> KARIN RUDD <br /> 4 Notary Public <br /> State of North Dakota 414 t <br /> My Commission Expires March 7,2020 1 Notary ublic <br />