}
BOND
Witness by these Presents:
That ___________________________________________________________________________________________
doing business under the name of ___________________________________________________________________
_______________________________________________________________________________________________
located at ______________________________________________________________________ Street, in the City of
_________________________ , County of ________________________________________ and State of Indiana, as
principal, and ___________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
as sureties, are bound unto the State of Indiana in the sum of ONE THOUSAND DOLLARS, for the payment of which we
bind ourselves, our heirs, executors and administrators, jointly and severally.
Witness our hands and seal this ___________________ day of _________________________________, 20 _______
The Conditions of this Obligation are such, that ______________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
has been licensed by the Indiana Department of Revenue to operate and maintain a private employment agency at
_____________________________________________ Street, in the City of _________________________________
County of _____________________________________ , State of Indiana ____________________________________
in accordance with the provisions of Tit. XXV Ch. 16, as amended.
_______________________________________________________________________________________________
_______________________________________________________________________________________________
shall faithfully observe all the duties, terms, conditions, provisions and requirements of the law in relation to private em-
ployment agencies, then this obligation is void; otherwise it is in full force and effect.
______________________________________ (Seal)
______________________________________ (Seal)
______________________________________ (Seal)
STATE OF INDIANA
ss:
______________________________________ County,
I, ________________________________________________________________________________ , certify that
_______________________________________________________________________________________________
_______________________________________________________________________________________________
who are personally known to me to be the same persons whose names are subscribed to the foregoing instrument, ap-
peared before me this day in person, and acknowledge that they signed, sealed and delivered said instrument as their
free and voluntary act for the uses and purposes therin set forth.
Indiana Department of Revenue
Form EA-2—1M—11-09
