Bond {BCO-160}

(Rev.1-03) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF CHARITABLE ORGANIZATIONS 207 NORTH OFFICE BUILDING HARRISBURG, PA 17120 (717) 783-1720 1-800-732-0999 (WITHIN PA) FAX (717) 783-6014 BOND - FORM BCO-160 BE IT KNOWN, That the applicant for registration, NAME OF APPLICANT a/an INDIVIDUAL, ASSOCIATION, PARTNERSHIP OR CORPORATION with business located at STREET MUNICIPALITY COUNTY STATE ZIP CODE as PRINCIPAL, and_______________________________________________________________________________________________________________ NAME OF SURETY COMPANY with principal office located at_________________________________________________________________________________________ STREET MUNICIPALITY COUNTY STATE ZIP CODE as SURETY, are held and firmly bound unto the Commonwealth of Pennsylvania for the use of the Secretary, Attorney General and any person having a cause of action against the principal as defined in the Pennsylvania Solicitation of Funds for Charitable Purposes Act, 10 P.S. §162.1 et seq., in the sum of Twenty-five Thousand Dollars ($25,000), lawful money of the United States of America, to be paid to the said Commonwealth, its certain attorney or assigns, to which payment well and truly to be made, we do hereby bind ourselves, jointly and severally, our heirs, executors, administrators, successors and assigns firmly by these presents. BECOMES EFFECTIVE this ________ day of ______________________ , 20_______ EXPIRES one year from date. WHEREAS, the above bounded Principal desires to operate as a Professional Solicitor under the provisions of the Pennsylvania Solicitation of Funds for Charitable Purposes Act, 10 P.S. §162.1 et seq., and the rules and regulations adopted pursuant thereto; NOW THEREFORE, the condition of this obligation is such that if upon and after the issuance of such registration the above bounded Principal shall fully and faithfully observe the provisions of all the laws of this Commonwealth and the rules and regulations promulgated by the Bureau of Charitable Organizations, Commonwealth of Pennsylvania, as a Professional Solicitor, then this obligation shall be void; otherwise, it shall remain in full force, virtue and effect. And the obligors, jointly and severally, for themselves, their heirs, executors, administrators, successors and assigns, do agree with the Commonwealth of Pennsylvania that upon violation of any provisions of the said Solicitation of Funds for Charitable Purposes Act, 10 P.S. § 162.1 et seq., and the rules and regulations promulgated by the Bureau of Charitable Organizations, said Bond up to the full amount shall be due and payable. 7 American LegalNet, Inc. www.FormsWorkFlow.com DATE SIGNATURE OF PRINCIPAL OFFICER FOR PROFESSIONAL SOLICITOR TYPE OR PRINT NAME AND TITLE OF PRINCIPAL OFFICER FOR PROFESSIONAL SOLICITOR DATE SIGNATURE OF ATTORNEY-IN-FACT FOR SURETY COMPANY TYPE OR PRINT NAME OF ATTORNEY-IN-FACT FOR SURETY COMPANY (Certified Copy of Power-of-Attorney nominating, constituting and appointing said Attorney-in-Fact for said Surety Company must be attached hereto. Date of certification and date of execution of Bond must agree). 8 American LegalNet, Inc. www.FormsWorkFlow.com