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INDEMNITY BOND ON LOST INSTRUMENT Whereas,. .......... .g.r.~.~.~3..J..p_.e.....!~.~y.j..d..~.~..n. .............................................. hereinafter designated as claimant, claims to be the owner and entitled to the payment of a certain.. dated ......... ff. ane _[~._.2.0.0.0 ................................ due...._. ~u~o_..l_~a_..~.O.O.~. ................................... payable to .........~.~.~.s.~.iD.~.._D~.~.~ 9n .................................................................................... $104.81 for the sum of......QB.~....~P.D.~.~....~.9.~.E. executed by ......... .~ ~.~.~...~ ~ ~.~.~...~ ~.~.~.E.~ · ~.~.~ ......................................................................... but is unable to produce or surrender said instrumeot upon such payment on account of its loss~ destruction, or otherwise. NOW, THEREFORE, If ........................................................................................................................... hereinafter designated as oblige% will pay or canse to be paid to ~ald claimant, or order, the amount demanded by him by virtue thereof~ we~ the underslgned~ do jointly and severally promise, undertake and agree to and with said obllgee, his or its successors~ helrs~ administrators and assigns~ that we will s~ve said obllgee, his or its successors, heirs, administra- tors and assigns~ harmless from any and all claims of any person or persons in and to said instrument~ or to the pay- ment thereof, in whole or in part, and from any and all damages, remote or proximate, sustained by virtue of s~id payment~ includingaH attorney's fees, costs, expenses~ charges, or llabi[itles assumed, incurred or expended, and will at any time upon demand pay or cause to be paid to said obligee, in addition theret% the amount so paid to said claimant by said obllgee with accrued interest thereon from the date of such payment at the rate of .... per cent per annum and undertake and perform any and all steps, actions or proceedlngs which said obligee may deem necessary or requisite to save said obllgee harmless from further liability, cost~ expense or damage in the premises. Dated this ........ d~.Z'~ ............................. day ol ....... Si,neOnd Delive~ed in the Presence of / --- -~---~~ ............. (S~AL) .................... Z~.f~.L.._d~Z~ .................................. [ ..................................................................... ,SEAL, ............................................................................................ ~ ............................................................................. (SEAL) STAT~ NO~K~TA ~ss County o[..~ ~ J ' 1.. [StatoofN~koto On this ....... [.~L ._. .................. 4ay of..._.~1~ ..................... ~ ~'~/~efore me, persoually appeared....C~t~.z.~-.....Z~.EL~ &~ .......................................................... and ............................................................................................................................. known to me to be the persons who are described in and who executed the within in~trument~ and, who, each for hlmself~ personally acknowledged to me that they executed the sa~e~ f and .............................................................................................. being first duly sworn, upon oath, each for himself doth say: The he is one of the sureties on, and who executed the within and foregoing bond. That he is a freeholder of the State of North Dakota and a resident of the said County o£ ...................................................... , North Dakota. That he is worth the sum o£ ................................................................................................................... Dollars in propert~ within this state over and above all his debts and liabilities and exclusive of all his property exempt by the laws of this State from levy and sale on execution or attachment. Subscribed and sworn to before me this ...................... day of. ................................................................ My commission expires ........................................................................................................................................