KANSAS SECRETARY OF STATE Contact Information Kansas Secretary of State Memorial Hall, 1st Floor 120 S.W. 10th Avenue Topeka, KS 66612-1594 (785) 296-4564 kssos@sos.ks.gov www.sos.ks.gov Warehouseman Bond All information must be completed and the required fee submitted or this document will not be accepted for filing. Please read all instructions before completing this document. WB 55 Know All Persons By These Presents: That we, _________________________________________________ of ________________________________________________________, as Name of applicant principal, and _____________________________________________ of Name of surety Do not write in this space _________________________________________________ , as sureties, are held firmly bound unto the state of Kansas in the sum of $_______________________, lawful money of the United States, to the payment of which we bind ourselves, our heirs, executors, administrators and assigns, firmly by these presents. The condition of the above obligation is such that, whereas, the above-bounden principal, _____________________________________________, was duly licensed to become a bonded warehouseman, and authorized toadvertise and operate a bonded warehouse for the period ending December 31, _______. Now, therefore, if the said principal named ______________________________________________________ shall well and faithfully perform and discharge the duties and responsibilities of a bonded warehouseman, as provided by the laws of the state of Kansas, and of such additional obligations as a warehouseman which may be assumed by the principal under contract with any owner depositing goods with the principal or with any purchaser or holder of warehouse receipts issued by the principal, and shall fully comply with all of the laws of this state relating to bonded warehouses and bonded warehousemen, then this obligation is to be void and of no effect; otherwise it shall remain in full force and effect. Executed on the ________ of ______________, ___________. Day Month Year Principal Surety Instructions 1. Submit this form with application and $40 license fee. 2. The amount of bond is based on percentage of capacity of the warehouse operated as a bonded warehouse. The minimum bond is $5,000 and the maximum bond is $50,000. Example: If 30% of the warehouse is operated as a bonded warehouse, the bond would be $15,000 (30% of $50,000). The bond must bear the seal of a surety company, must be signed by an attorney in fact, and must be accompanied by a power of attorney. Notice: There is a $25 service fee for all checks returned by your financial institution. Rev. 12/28/10 jdr K.S.A. 82-165 American LegalNet, Inc. www.FormsWorkFlow.com