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GENERAL NOTARY PUBLIC BOND FORM If this sample bond form is used by YOUR Bonding or Insurance Agent it MUST BE SIGNED AND SEALED by the Agent and/or be accompanied by an agency power of attorney attachment. KNOW ALL MEN BY THESE PRESENTS THAT Of the town of in the county of and State of Nebraska lately appointed General Notary Public within and for said State of Nebraska as principal and as surety is held and firmly bound unto the State of Nebraska in the penal sum of FIFTEEN THOUSAND DOLLARS good and lawful money of the United States to be paid to the State of Nebraska for which payment well and truly made we bind ourselves our heirs executors and administrators jointly and severally by these presents Whereas the above bounden has been appointed to the office of General Notary Public within and for said State of Nebraska for a term of four years FROM EFFECTIVE DATE OF COMMISSION. Now the conditions of the above obligation are such that if the said principal shall faithfully and in all things perform all duties required of him/her by law as a General Notary Public within and for said State during his/her continuance in office by virtue of said appointment then the above obligation to be void else to remain in full force. GENERAL NOTARY PUBLIC BOND FORM If this sample bond form is used by YOUR Bonding or Insurance Agent it MUST BE SIGNED AND SEALED by the Agent and/or be accompanied by an agency power of attorney attachment. KNOW ALL MEN BY THESE PRESENTS THAT Of the town of in the county of and State of Nebraska lately appointed General Notary Public within and for said State of Nebraska as principal and as surety is held and firmly bound unto the State of Nebraska in the penal sum of FIFTEEN THOUSAND DOLLARS good and lawful money of the United States to be paid to the State of Nebraska for which payment well and truly made we bind ourselves our heirs executors and administrators jointly and severally by these presents Whereas the above bounden has been appointed to the office of General Notary Public within and for said State of Nebraska for a term of four years FROM EFFECTIVE DATE OF COMMISSION* Now the conditions of the above obligation are such that if the said principal shall faithfully and in all things perform all duties required of him/her by law as a General Notary Public within and for said State during his/her continuance in office by virtue of said appointment then the above obligation to be void else to remain in full force. SEALED WITH OUR SEALS and dated this day of 20. Signature of Applicant Nebraska Resident Agent Surety Company STATE OF NEBRASKA County of United States and the constitution of the State of Nebraska and that I will faithfully and impartially perform the duties of the office of General Notary Public according to law and to the best of my ability. And I do further swear that I do not advocate nor am I a member of any political party or organization that advocates the overthrow of the government of the United States or of this State by force or violence and that during such time as I am in this position I will not advocate nor become a member of any political party or organization that advocates the overthrow of the government of the United States or of this State by force or violence.

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