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CASS COUNTY GOV 7012982395 03/12 '04 12:43 N0.589 05/06 SIGNED and SEALED this day of 2004, (~,M. OF PRINCIPAl.) Title: PRINCIPAL SURETY COMPLETE MAILING AOORES~ IMPORTANT NOTICE An individual doing business unde~ a firm name must give nameS, and ~e individual shall designate himself as sole owner. If a partnership, so state, end at least one member of such partnership must sign. If e corporation, the full corpo- rate name must be used end the execution must be by an ofl~cer of the corporation. (Se, A6 OF By: Title: COMPLETE MAILING ADDRESS Any other person executing for the principal or surety must at- tach a power of attorney. NOTICE TO SURETY Section 26.1-03.01, N.D.C.C. Provides: "Limitation on risks acceptable by company, An insurance company transacting an insurance business in this stets may not expose itself to loss on any one risk or hazard to an amount exceeding ten percent of its paid-up capital and surplus if a stock company, or ten percent of its surplus if a mutual company, unless the excess is reinsured." If excess reinsurance agreements are required on this bond, an affidavit executed by en officer of the surety shall be attached, stating that such reinsurance agreements have been entered into and are in effect at the time the bond is executed, giving the name an address of all companies with Whom such agreements have been entered, and that copies of such reinsurance agreements will be furnished to the North Dakota commissioner of Insurance. ACKNOWLEDGMENT OF PRINCIPAL State of County of On this .day o[ 2004, before me a notary public In and for the state of , personally appeared .. , known to me to be (title) of the prin~ipal described in the within instrument and who executed the same and aoknowledged to me that the same was executed for and on behalf of said principal. Notary Public, State of (Notary PuMla mum i~nt of type 6ama' here.) My Commission expires_ 2 of 3 (NO'rARY ~AL)