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This is a New York form that can be used for Miscellaneous within Secretary Of State.
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STATE OF NEW YORK · DEPARTMENT OF STATE Games of Chance Surety Bond KNOW ALL MEN BY THESE PRESENTS, that a corporation duly authorized and existing under the laws of the state of place of business at and (Name of Surety) BOND NUMBER (Name of Corporation) , and having its principal , as principal, , , as surety are held firmly bound to the people of the State of New York in the sum of $ pursuant to Section 369-e of the General Business Law; that the principal binds itself, its successors and assigns and the surety binds itself, its heirs, executors and administrators and assigns. THE CONDITION OF THIS OBLIGATION IS SUCH THAT: WHEREAS, the principal has filed with the Secretary of State of the State of New York to engage in a game, contest, promotion, advertising scheme or plan pursuant to Section 369-e of the General Business Law; NOW, THEREFORE, if the principal performs and fulfills all of the undertakings and obligations as offered in such game, contest, promotion, advertising scheme or plan as provided in Section 369-e of the General Business Law, then this obligation shall be null and void; otherwise, it shall remain in full force and effect. IN WITNESS WHEREOF, the principal and the surety have signed this instrument on the day and year indicated below. Date: (Name of Principal) By: Title: Date: (Surety) STATE OF COUNTY OF s.s.: On this day of , 20 , before me personally came the above named individual, to me known and who, being duly sworn by me, did depose and say that (he)(she) resides at ; and that (he)(she) is the of the corporation described in and that executed the foregoing instrument. (Notary Public) STATE OF COUNTY OF s.s.: On this day of , 20 , residing at , before me personally came , to me known and known to be the same person described in and that executed the foregoing instrument and who acknowledged to me that (he)(she) executed the same. (Notary Public) DOS-0261-F-L (Rev. 07/11) American LegalNet, Inc. www.FormsWorkFlow.com