I . ....................... (name of agent), as ....................................... (title of agent) for .............................. (name of surety), a corporation/mutual insurance company/other (indicating type of business organization) (circle one) domiciled in ......................... (state of domicile), DO HEREBY CERTIFY that, to the best of my knowledge, the foregoing statements made by me are true, and ACKNOWLEDGE that, if any of those statements are false, this bond is VOIDABLE.
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(Signature of certifying agent)
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(Printed name of certifying agent)
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(Title of certifying agent)