Page 1 of 2 Form 2-62.2 (0/201) ASSIGNMENT (FOR CONDUCT SURETY PURPOSES ONLY) 2-62.2 (0/201) (1) hereinafter called assignor, whose principal place of business is (2) (3) , Texas, do (does) hereby assign, and set over the Texas Alcoholic Beverage Commission of the State of T exas, all right, title and interest of whatever nature, of assignor, in and to the insured account of assignor in the (4) evidenced by (5) in the amount of (6) $ numbered (7) Assignor agrees the this assignment carries with it the right to the insurance of the account by the (8) and includes and gives the right to the Administrator of the Texas Alcoh olic Beverage Commission of the State of Texas to redeem, collect, and withdraw the full amount of such account at any time WITHOUT NOTICE TO THE ASSIGNOR. The condition of the obligation of this assignment is such that the permittee or licensee shall fai thfully conform with the Texas Alcoholic Beverage Code and Rules of the commission. If the holder of this permit or license violates a law of the state relating to alcoholic beverages or a rule of the commission, the amount of the certificate of deposit s hall be paid to the state. Assignor herby notifies the above named (4) of the assignment. SIGN Date HERE (Signature of Assignor) RECEIPT FOR NOTICE OF ASSIGNMENT Receipt is acknowledged to the Administr ator of the Texas Alcoholic Beverage Commission of the State of Texas of written notice of the assignment to said State of Texas of the account identified above. We have noted in our records nment. We certify that we have received no notice of any lien, encumbrance, hold, claim, or obligation of the above - identified account prior to assignment to the State of Texas. We agree to make payment by mail to the State of Texas upon demand by mail i n accordance with the laws applicable to this (9) . Date SIGN HERE (Signature of Bank Officer) (Title of Bank Officer) Name of Bank Address City, State, Zip Area Code & Phone No. INSTRUCTIONS (1) Name of Applicant: IF: Corporation ------------------------------------ Corporate name must be shown Partnership ------------------------------------ must be shown Limited Partnership -------------------------- Name of limited partnership and general partner must be shown Private Club ----------------------------------- Name of the club must be shown - (If Corporation - Corporate name) Proprietorship --------------------------------- Name of individual must be shown Limited Liability Partnership --------------- must be shown Limited Lia bility Company ----------------- Name of limited liability company must be shown (2) Trade Name of Business (6) Amount in words and figures (3) Actual Business Address and City (Not Mail Address) (7) Number of C.D. or Savings Account (4) Name of Bank, as sociation or credit union (8) Name of U.S. Agency insuring deposit (5) Description of automatically renewable time Certificate of Deposit or Savings Account (9) Bank, association or credit union THE ASSIGNMENT OF THIS CERTIFICATE OF DEPOSIT OR SAVINGS AC COUNT PASSBOOK PROHIBITS THE BANK FROM DISPERSING THE PRINCIPAL MONIES ASSIGNED TO THE TEXAS ALCOHOLIC BEVERAGE COMMISSION UNTIL RELEASED OR DISCARDED, IN WRITING, BY THE TEXAS ALCOHOLIC BEVERAGE COMMISSION. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form 2-62.2 (0/201) ACKNOWLEDGMENTS No. 1 (FOR ASSIGNOR) BEFORE ME, the undersigned authority in and for said State on this day personally appeared known to me to be the person whose name is subscribed to the (Name of Assignor) foregoing instrument, and acknowledged to me that he or she executed the same, for the purposes and considerations therein expressed. Given under my hand and sea l of office, this day of A.D., SIGN HERE (S E A L) Notary Public No. 2 (FOR BANK OR SAVINGS ASSOCIATION) BEFORE ME, the undersigned authority in and for said State on this day pers onally appeared known to me to be the person whose name is subscribed to the (Name of Bank Officer) foregoing instrument, and acknowledged to me that he or she executed the same as the act and deed of the surety company thereof, and for the purposes and considerations therein expressed, and in the capacity therein stated. Given under my hand and seal of office, this day of A.D., SIGN HERE ( S E A L) Notary Pub lic NO. 1 ASSIGNOR Name of assignor (permittee/licensee) who signed the assignment must be shown. Notary public must date, sign the acknowledgment and affix notary seal. NO. 2 BANK OR SAVINGS ASSOCIATION Name of bank officer who signed the assignme nt must be shown. Notary Public must date sign the acknowledgment and affix notary seal. INFORMATION 1. As required under Section 11.11 and 61.13 , t his assignment form may only be used for Conduct Surety purposes and the certificate of deposit or savin gs account must be issued by a Texas bank, savings institution or credit union. 2. exemption from the surety requirements, the licensee or perm ittee may request (in writing) the release and return of the security supporting their license or permit. 3. The release of this security will not be unreasonably withheld; however, the bank, savings institution or credit union is not released from its obliga tion until they receive written notice of the release from this agency. American LegalNet, Inc. www.FormsWorkFlow.com