IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ) ) ) ) ) ) ) ) ) ) ) Plaintiff, vs. CASE NO. JUSTIFICATION OF SURETIES , being duly sworn, state that: Defendant. I, 1. I am a resident of Alaska. , 2. I am worth the amount of the bond which I signed as surety, $ exclusive of property exempt from execution, and exceeding all my just debts and liabilities. a. My assets, any outstanding liens and exemptions are as follows: Description or Location Cash Auto/Truck Business Stocks/Bonds Real Property Total: b. I understand my right to exemptions from execution under AS 09.38 and have determined that I am entitled to no exemptions other than those listed in the third column above. [See Judgment Debtor Booklet, CIV-511, for description of exemptions.] I have the following outstanding judgments, lawsuits and other possible claims pending against me or any partnership or unincorporated association of which I am a member: I will not sell, mortgage, encumber, or in any manner whatsoever, convey or impair my interest in the property listed above without written permission of the Court. Value Outstanding Liens Exemptions from AS 09.38 c. d. 3. I am not an attorney at law, peace officer, clerk of any court, or other officer of any court. Surety Signature Mailing Address City Typed or Printed Name State ZIP Daytime Phone Alaska on . Subscribed and sworn to or affirmed before me at, (SEAL) CIV-655 (9/96)(cs) JUSTIFICATION OF SURETIES Notary Public/Judge/Clerk of Court My commission expires: Civil Rule 80(d) American LegalNet, Inc. www.USCourtForms.com