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Get FCS Prem Rcpt FL 2007

6. Charged with: 7. Collateral Receipt No. ) Money Order ---- PREMIUM ON BOND(S) FOR: Bond Amount: $ Court: issued. (ENTER RECEIPT # OR “NONE”) NOTICE: SEE REVERSE SIDE Amt. Due $ Received By: Amt. Pd. $ (Signature) (Print) In Behalf of Agent for: Financial Casualty & Surety, Inc. (fcs) Bal. Due $ ________________________ PO Box 4479, Houston, TX 77210-4479 877-737-2245 FCS Prem Rcpt FL (2/2007) PAYOR’S COPY Reverse Side ANY OF THE FOLLOWING HAPPENINGS SHALL CONSTITUTE A B.

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