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i <br /> Indemnity Bond on Lost Instrument <br /> NDCC 21-06-03 <br /> Evan Hiller, claims to be the owner and entitled to payment of a certain warrant <br /> number 261606 dated 3/30/2012 for the sum of$40.00, 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, Evan Hiller, as principal,jointly and severally undertake, promise and agree to <br /> pay any amount of loss that may be sustained by Cass County by reason of the issuance of a <br /> duplicate in the said sum of$40.00, 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 �' �� , 20/y. <br /> a <br /> ? /� -C <br /> 24•h,/ /4,1 / r- <br /> STATE OF N9 r-P1 "kek, ) <br /> - ) SS <br /> COUNTY OF^ riPor-)c ) <br /> ,� <br /> On this /day oflis7� , 20 J7, before me personally appeared Evan Hiller, <br /> known to me to be the person(s) described in and that executed the within instrument and <br /> severally acknowledged to me that they executed the same. <br /> LA'...._ <br /> Notary ilic <br /> MARY ANN LINDGREN <br /> Notary Public <br /> State of North Dakota <br /> 1 My Commission Expires April 18,2019 ■ <br />