Secretary of St a te OFFICE OF SECRETARY OF STATE CORPOR A TIONS DIVISION 313 West Tower 2 Martin Luther King Jr. Dr. Atlanta, GA 30334 (404) 656 - 2817 sos.georgia.gov/corporations Registration of Priva t e Child Support Collector SUR E T Y B O ND O.C.G.A. 247 10 - 1 - 393.9 Applicant Bond No.: KNOW ALL MEN BY THESE PRESENTS: Tha t we, (Name of Private Child S u pport Collec t or) o f AS PRINCI P AL, and , (Address) , (Name of Suret y ) o f , (Address) AS SURETY, a corporation organized and existing under the laws of the State of , and authorized to transact business as s u rety in the State of Georgia, are her e by held and fi r m ly bound unto the State of Georgia, for the use and benefit of all interested p e rsons inju r ed by any breach of the conditions of this obligati o n, a nd co n d iti on ed on the P R c o m p liance with O.C.G.A. 247247 10 - 1 - 3 93.9 and 10 - 1 - 393 . 10 and the faithful performance of the obligations under the P R agreements with its clients, in the s u m of Fif t y T h o u sand ($50 , 0 0 0.00) Dollars lawful m oney of the United States of America, for the pa y m ent of which s u m , well a n d truly to be made, we bi n d ourselves, our heirs, executors, ad m i n istrators, suc c essors and a s signs, jointly and severall y , fir m ly by these presents. SEALED wi t h our seals and dated this day of , 20 . THE CO N D I TIONS OF T HE AB O VE OBLIGA T I O N ARE SU C H THAT: WHEREAS, the above - m entioned Prin c ipal has applied to the Secretary of State of the State of Georgia for registration as a Private Child Support Collector, representing by said application and by these presen t s, that all the statements set forth in said application to the S ecretary of State of Georgia, and that all of the written evidence or other probative m atter filed with the Secretary of State in connection with such a pplication, are true; and obligating itself and its agents to faithful co m p l i a n ce with all provisions of O.C.G.A. 247247 10 - 1 - 3 93.9 a nd 10 - 1 - 393 . 10, as now or hereafter amended; and WHEREAS, the above - mentioned Prin c ipal shall file all contracts for the collection of chi l d support between Principal and an obligee wi t h the Gove r nor ' s Office of Consu m er Affairs, in c o m p liance with the require m ents set forth in O.C.G.A. 247 10 - 1 - 393 . 10, a n d that all of the statements set forth in said contracts filed American LegalNet, Inc. www.FormsWorkFlow.com with the Office of Cons u m er Affairs are true, obligating itself and its agents to the faithful c o m p liance with all provisions set forth i n said Code section, as n o w or hereafter a m ended. NOW, THEREFORE, the condition of t h is obl i g ation is such, t h at if the Secretary of State of the State of Georgia shall register t h e above bou n den Principal as such Private Child Sup p ort Collector and said Principal shall faithfully and honestly act as such Private Child Support Collector in accordance with law, and fully c o m p ly with the provisio n s of O.C.G.A. 247247 10 - 1 - 3 9 3.9 and 10 - 1 - 393 . 10, and t h e acts amendato r y thereof and supplemental thereto, and if the Princi p al shall full i nde m n ify and save har m less from loss t h e State of Georgia and any person who m ay have a cau s e of action against the Principal for any m alfea s ance or misf e asan c e i n the conduct of p r ivate child support collect i on as such Private Child Support C o llector, then this obligati o n s h all be void, otherwise to re m ain in full force and vir t ue. IN WITNE S S WHEREOF, said Principal, acting by and t h ro u gh its d ul y authorized o f ficers, has hereunto set its hand and s eal, and the said Surety h a s ca u sed the s e presents to be signed by its duly authorized officers, and its corporate seal to be hereto a ffixed this d a y of , 20 . Name of Principal: By: Title: Signed and s e aled in m y p r esence this d a y of , 20 . Official Witness (Notar y ) (Seal) Name of Surety: By : Title: Signed and s e aled in m y p r esence this day of , 20 . Official Witness (Notary) (Seal) American LegalNet, Inc. www.FormsWorkFlow.com