Securities Division and Charities Division Office of the Georgia Secretary of State 2 Martin Luther King Jr. Drive SE Suite 820 West Tower ­ Atlanta, GA 30334 (478) 207-2440 http://www.sos.ga.gov Brian P. Kemp Secretary of State Applicant: Georgia Charitable Solicitations Act Paid Solicitor Registration Paid Solicitor Bond Noula Zaharis Division Director KNOW ALL MEN BY THESE PRESENTS: That we, of As Principal, and as surety, are held and firmly bound unto the Secretary of State of the State of Georgia, for the use of the State of Georgia , and to any person who may have a cause of action against the Principal for any malfeasance or misfeasance in the conduct or solic itation by the Principal as a Paid Solicitor, in the sum of $10,000.00, lawful money of the United States of America, to be paid to t he Secretary of State of the State of Georgia for the use of the State of Georgia and to any person who may have a cause of action against the Principal for any malfeasance or misfeasance in the conduct of solicitation by the Principal as a Paid Solicitor , as their interests may appear, not exceeding in the aggregate the said sum of $10,000.00 for which payment well and truly to be made we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally by these presents, in acc ordance with the terms, limitations and conditions set forth in O.C.G.A. § 43-17-4. WHEREAS, the above bounden Principal has applied to the Secretary of State of the State of Georgia for registration as a Paid Solicitor for the purpose of acting as a Paid Solicitor for a charitable organization required to register with the Secretary of State of the State of Georgia pursuant to O.C.G.A. § 43-17-1 et seq. (Charitable Solicitations Act of 1988) (hereinafter "Act"). NOW, the condition of this obligation is such, that if the Secretary of State of the State of Georgia shall register the above bounden Principal as such Paid Solicitor and said Principal shall faithfully and honestly act as such Paid solicitor in accordance with law, and fully comply with the provisions of the Act, and the acts amendatory thereof and supplemental thereto, and if the Pr incipal shall fully indemnify and save harmless from loss the State of Georgia and any person who may have a cause of action against the Principal for any malfeasance of misfeasance in the conduct of solicitation as such Paid Solicitor then this obligation shall be void, otherwise to remain in full force and virtue. This bond shall not become void upon the first recovery thereon but may be sued upon from time to time until the full amount thereof shall have been exhausted. This bond is to cover all claims arising on account of the registration of the Principal and his acting as such Paid Solicitor for the full term hereof beginning on _______________________ and expiring on December 31, ___________. IN WITNESS WHEREOF we have hereunto set our hands and seals on this _____ day of ______________, 20____. Name of Principal: _______________________________________________________________________ By: ___________________________________________________________________________________ (Seal) Title: __________________________________________________________________________________ Signed and sealed in my presence this _____ day of ______________, 20_____. _________________________________________ Official Witness (Notary) Name of Surety: _________________________________________________________________________ By: ____________________________________________ Title: ___________________________________________ Signed and sealed in my presence this _____ day of _______________, 20_____. ________________________________________________ (Seal) Form S100D Revised Aug 2012 American LegalNet, Inc. www.FormsWorkFlow.com