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%_0 <br />LJ <br />Surety <br />Address <br />Phone No. <br />Witness By <br />Signature <br />—(7�ped or Printed Name of Signer <br />Title <br />Local Address b Telephone Number <br />(The attorney -in -fact shall attach here- <br />to a copy of his power of attorney or <br />other document which authorizes him to <br />act on behalf of and to bind the surety.) <br />-52- <br />3s9s. <br />4/81 <br />