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<br />(Sec. 21.06-03. J2_02-01. N. D. C. Co\
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<br />INDEMNITY BOND ON LOST INSTRUMENT
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<br />Whereas,...~~...4.~...................................................................hereinafter designated as claimant, !:
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<br />claims to be the owner and entitled to the payment of a certain...d~.&:..:,..<P.Jle.$!Q......~..'/'l.5.3.....+..... Ii
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<br />dated...~JJk9.)Q....1~.lQ~.Q.7.........~.i?;ff./~:8...I.~.:~:.~.7.due..........1.=!~..."-1.....",:......jg~l..!:!o..:r::.'3?:.~~........ Ii
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<br />payable to.........siJ.~.,J;.M!I~................................................................................................................... j!
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<br />for the sum OL.J!...75.:~.5C.......................Q[~..~...*'!:'='....~~..2.l>C)........................................Dollars, 'I,ll'
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<br />othe;~~, THEREFORE, IL........m...~~....J;/!!./.w........................h....h..h..............h.hm.....h..h.hereinafter
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<br />designated as obligee, will payor cause to be paid to said claimant, or order, the amount demanded by him by virtue
<br />thereof, we, the undersigned, do jointly and severally promise, undertake and agree to and with said obligee, his or
<br />its successors, heirs, administrators and assigns, that we will save said obligee, his or its successors, heirs, administra- 11
<br />tors and assigns, harmless from any and all claims of any person or persons in and to said instrument, or to the pay- I,
<br />ment thereof, in whole or in part, and from any and all damages, remote or proximate, sustained by virtue of said 11
<br />payment, including all attorney's fees, costs, expenses, charges, or liabilities assumed, incurred or expended, and will Ii
<br />at any time upon 'demand payor cause to be paid to said obligee, in addition thereto, the amount so paid to said I!
<br />claimant by said obligee with accrued interest thereon from the date of such payment at the rate oLou....mper cent
<br />per annum and undertake and perform any and all steps, actions or proceedings which said obligee may deem necessary
<br />or requisite to save said obligee harmless from further liability, cost, expense or damage in the premises.
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<br />'/--- Dated this........3\.~...m...m'''''''''''''hm........day oL...IV\M.c,.t-\
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<br />On thiS.h....S/.S:r:-:.....h.....m;e:......h..day oL../!"k..cv<:..l.............h............ln the year ~"h'" before me,
<br />persoll all y a ppea red.... ..d!c.c6....... .....~:.:.d,,~.~,.. .................. .h... ............ .h.h .......................h.. m.... "''''h..h ....hh .......h....
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<br />and....h..........h...........mh...m..............,............'..............................h...................h.....................m...................................h.......
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<br />known to me to be the persons who are described in and who executed the within instrument, and, who, each for
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<br />C:::;:f.~.~.:~~~:..:A.:~~~.... } ss.
<br />
<br />DEANN K. BUCKHOUSE
<br />Notary Public
<br />State of North Dakota
<br />My Commission expires Dee, 18,2012
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<br />and....m........m..nm..........................m..........o.m...................m........_..o-being first duly sworn, upon oath, each for himself
<br />doth say: The he is one of the sureties on, and who'executed the within and foregoing bond. That he is a freeholder of
<br />the State of North Dakota and a resident of the said County oL..........................................................., North Dakota.
<br />That he is worth the sum oL--......h............m..........................._..........___........o.....__n.........................nm._....m..unm....mDollars
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<br />in property within this state over and above all his debts and liabilities and exclusive of all his property exempt by
<br />the laws of this State from levy and sale on execution or attachment.
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<br />Subscribed and sworn to before me this..........._..........
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<br />day of..........................................................
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<br />Receive and file Lost Instrument Bond for Birch Burdick and authorize the
<br />county auditor and county treasurer to issue duplicate checks.
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