1 REVISOR 2875.9915 2875.9915 FORM 172: BOND FOR INVESTMENT ADVISER. [BOND FOR INVESTMENT ADVISER] KNOW ALL BY THESE PRESENTS, That we, _______________ __________________________________________________________, as Principal, and _________________________________ a qualified and authorized to do business in the State of Minnesota, as Surety, are held and firmly bound unto the STATE OF MINNESOTA for the use and benefit of any interested person, in the sum of $25,000.00, lawful money of the United States of America, to be paid to the State of Minnesota for the use and benefit aforesaid, for which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That Whereas the above named Principal has made application to the State of Minnesota, Department of Commerce, for licensing as an Investment Adviser within the meaning of the Minnesota Securities Act and is required to furnish a bond in the sum above named, conditioned as herein set forth: NOW, THEREFORE, If the Principal, their agents and employees, shall strictly, honestly and faithfully comply with the provisions of the aforementioned Minnesota Securities Act, and shall pay all damages suffered by any person by reason of the violation of any of the provisions of the Act, or Acts amendatory thereof and supplementary thereto, now or hereafter enacted, or by reason of any fraud, dishonesty, misrepresentation, or concealment of facts materially affecting the value of any securities connected with, or growing out of any transaction contemplated by the provisions of this Act, then this obligation shall be void; otherwise to remain in full force and effect. THIS BOND shall become effective on the ______________, and shall remain in force until the Surety is released from liability by the State of Minnesota, Department of Commerce, or until this bond is canceled by the Surety. The Surety may cancel this bond and be relieved of further liability hereunder by giving thirty (30) days' written notice to the Principal and to the Department of Commerce, of the State of Minnesota. THIS BOND shall be one continuing obligation, and the liability of the Surety for the aggregate of any and all claims which may arise hereunder shall in no event exceed the amount of the penalty hereof. No suit may be maintained to enforce any liability on the bond, unless brought within three years after the sale or other act upon which it is based. IN WITNESS WHEREOF, we have hereunto set our hands and seals this ______ day of ___________, ____. Copyright ©2009 by the Revisor of Statutes, State of Minnesota. All Rights Reserved. American LegalNet, Inc. www.FormsWorkflow.com 2 REVISOR 2875.9915 WITNESS: ________________________________ _______________________________ ________________________________ ATTEST: _______________________________ ________________________________ By ____________________________ (INDIVIDUAL ACKNOWLEDGMENT) State of ________________ ) ) SS. County of ______________ ) On this ______day of ________, ____, before me, a Notary Public within and for said county, personally appeared, ____________, to me known to be the person described in and who executed the foregoing instrument, as Principal, and acknowledged to me that ..he executed the same as a free act and deed. (NOTARIAL SEAL) _______________________________ Notary Public, ___________________ County, _________________________ My Commission expires ___________ _______________________________ (CORPORATE ACKNOWLEDGMENT) State of ________________ ) ) SS. County of ______________ ) On this _____day of ________, ____, before me a Notary Public within and for said county, personally appeared, ___________________________, who being first duly sworn, says that ..he is the _________________________________________ of _________________________________, Principal herein, and executed the foregoing instrument for and in its behalf, by authority of its Board of Directors, that the seal affixed to the foregoing instrument is the corporate seal of said corporation; and further acknowledged said instrument and the execution thereof to be the voluntary act and deed of said corporation. Copyright ©2009 by the Revisor of Statutes, State of Minnesota. All Rights Reserved. American LegalNet, Inc. www.FormsWorkflow.com 3 REVISOR (NOTARIAL SEAL) 2875.9915 _______________________________ Notary Public, ___________________ County, _________________________ My Commission expires ___________ _______________________________ (SURETY ACKNOWLEDGMENT) (Corporate Officer) State of ________________ ) ) SS. County of ______________ ) On this _______day of ________, ____, before me, a Notary Public within and for said county, personally appeared ________________, who being first duly sworn, says that ..he is the ___________ of ___________, Surety herein, a corporation duly organized and existing under laws of the State of _________, and executed the foregoing instrument for and in its behalf, by authority of its Board of Directors; that the seal affixed to the foregoing instrument is the corporate seal of said corporation; and further acknowledged said instrument and the execution thereof to be the voluntary act and deed of said corporation. (NOTARIAL SEAL) _______________________________ Notary Public, ___________________ County, _________________________ My Commission expires ___________ _______________________________ Approved by the Department of Commerce this _____ day of __________, ____. By ____________________________ Commissioner of Commerce Statutory Authority: MS s 80A.25 History: L 1983 c 289 s 114 subd 1; L 1984 c 655 art 1 s 92; 17 SR 1279; L 1998 c 254 art 1 s 107 Copyright ©2009 by the Revisor of Statutes, State of Minnesota. All Rights Reserved. American LegalNet, Inc. www.FormsWorkflow.com 4 REVISOR 2875.9915 Posted: September 14, 2007 Copyright ©2009 by the Revisor of Statutes, State of Minnesota. All Rights Reserved. American LegalNet, Inc. www.FormsWorkflow.com