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BUREAU OF THE FISCAL SERVICE DEPARTMENT OF THE (Department of the Treasury - OCIO)

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DEPARTMENT OF THE TREASURY
BUREAU OF THE FISCAL SERVICE
HYATTSVILLE, MD 20782
*** LICENSE SHEET ***
OMB 1530-0009
Name of Company
State Of Incorporation
NAIC Company Code
NAIC Group Code
Contact Name
Contact Title
Contact Phone Number
Contact E-Mail
Date
Please indicate by an (X) the states and other areas in which your company is licensed to transact SURETY business as a DIRECT
WRITER. NOTE: If any restrictions have been imposed by states checked, include an explanation on an attached sheet. The
explanation should include the type, reason for and time period of the imposed restriction.
FISCAL SERVICE FORM 2208 (3-2000)
EDITION OF 1-97
IS OBSOLETE
AL Alabama
AK Alaska
AS Am. Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FL Florida
GA Georgia
GU Guam
HI
Hawaii
ID
Idaho
IL Illinois
IN
Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MD Maryland
MA Massachusetts
MI
Michigan
MN Minnesota
MS Mississippi
MO Missouri
MP Northern Mariana Islands
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
OH Ohio
OK Oklahoma
OR Oregon
PA Pennsylvania
PR Puerto Rico
RI
Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VA Virginia
VI
Virgin Islands
WA Washington
WV West Virginia
WI
Wisconsin
WY Wyoming
FOR TREASURY DEPT. USE ONLY
SIMS AUTH. NEEDED: YES/NO
INPUT AUTH. COMPLETED
INIT.
DATE
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BUREAU OF THE FISCAL SERVICE DEPARTMENT OF THE (Department of the Treasury - OCIO)

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Completed 10 August 2020

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