AO 411 (12/81) DEPOSIT OF SECURITY United States District Court for the Western District of Virginia VS. Case Number: I/We, , in said action herewith deposit(s) the with the Clerk of the United States District Court for the Western District of Virginia, (specify security, such as cash or certified check) in the sum of as security for costs that . may be adjudged or awarded against in the above entitled and number action on The condition of this deposit is that such security shall be returned to above named, if said , the shall answer for all costs that may be adjudged or awarded in such action. date date RECEIPTS I hereby acknowledge receipt of the above-described deposit of security for cost on appeal in the above entitled and numbered action. date signature and title 2002 © American LegalNet, Inc.