Form 2603 1 Form 2603227General Information (Automobile Club Assignment of Certificate of Deposit) The attached form is designed to meet minimal statutory filing requirements pursuant to the relevant code provisions. This form and the information provided are not substitutes for the advice and services of an attorney. Commentary Automobile Clubs are governed by Chapter 722 of the Texas Transportation Code (the 223Automobile Club Services Act224) and the secretary of state222s administrative rules found in 1 Texas Administrative Code Chapter 75. Section 722.004 of the Automobile Club Services Act requires an automobile club to accompany an application for certificate of authority with proof of $25,000 in security. The Automobile Club Services Act authorizes the secretary of state to approve security offered to satisfy this requirement. The secretary of state approves and will accept assignments of certificates of deposit containing the information set forth in this form in satisfaction of the security requirement. Instructions for Form Assignor: Provide the name and mailing address of the person to whom the certificate of depositwas issued.Automobile Club: Provide the name of the automobile club applying for the certificate ofauthority. The name of the automobile club must match the name on the application forcertificate of authority. The assignor and the automobile club are typically the same entity.Certificate of Deposit: Provide the number used by the financial institution to identify thecertificate of deposit.Financial Institution: Provide the name and mailing address of the financial institution orcredit union that issued the certificate of deposit. The issuing financial institution or credit unionmust be either: (1) a financial institution in Texas whose deposits are insured by the FederalDeposit Insurance Corporation or the Savings Association Insurance Fund; or (2) a credit unioninsured by the National Credit Union Administration.Agreement & Understanding of the Parties: A person who is authorized to sign on behalf ofthe assignor must sign and date the assignment.Acknowledgement by Financial Institution: Before the assignment form is submitted to thesecretary of state, a person authorized to sign on behalf of the issuing financial institution orcredit union must sign and date the assignment.Receipt for Security & Directions to Pay Earnings: Leave this section blank. Upon filing, thesecretary of state will execute this section authorizing the issuing financial institution or creditunion to pay any earnings on the certificate of deposit to the Assignor and send a copy of thefiled Assignment of Certificate of Deposit to the financial institution or credit union. Delivery Instructions: A copy of the document issued by the financial institution or credit unionthat evidences the existence of the certificate of deposit must be filed along with the executedassignment form. The documents may be mailed to Registrations Unit, P.O. Box 13, Austin,Texas 78711-3 or delivered to the James Earl Rudder Office Building, 1019 Brazos, Austin,Texas 78701.Revised 0/201 American LegalNet, Inc. www.FormsWorkFlow.com Form 2603 2 This space reserved for office use AUTOMOBILE CLUB ASSIGNMENT OF CERTIFICATE OF DEPOSIT Form #2603 Rev. 0/201 Submit to: SECRETARY OF STATE Registrations Unit P O Box 13 Austin, TX 78711-3 512-475-0775512-475-2815 - FaxFiling Fee: None.ASSIGNOR Name:Mailing Address City State Zip AUTOMOBILE CLUB Name: CERTIFICATE OF DEPOSIT Number: Payee: The State of Texas Amount:twenty-five thousand dollars ($25,000.00) FINANCIAL INSTITUTION Name: Mailing Address City State Zip AGREEMENT & UNDERSTANDING OF THE PARTIES In order to obtain a certificate of authority for the automobile club specified (the 223auto club224) and for thepurpose of providing security for injuries caused by the auto club222s failure to faithfully perform in selling orproviding club services or failure to pay any fines or penalties levied against the auto club for failure tocomply with the provisions of the Automobile Club Services Act, Transportation Code Chapter 722, theASSIGNOR specified, for the benefit of the state or any party injured by the auto club222s failure to faithfullyperform in selling or providing club services, in the name of the auto club, assigns and sets over irrevocablyto the secretary of state any and all right, title, claim and interest of whatever nature of ASSIGNOR in and tothe CERTIFICATE OF DEPOSIT (223CD224) described above. ASSIGNOR agrees that this assignment carries with it the right to any insurance on the CD that may now orin the future exist and includes and gives to the secretary of state the exclusive right to redeem, collect andwithdraw at any time any part of or the full amount of the CDto be applied as a payment to the state or toany party injured by the auto club222s failure to faithfully perform in selling or providing club services. (Theright of the secretary of state to apply the CDshall not be affected by a subsequent change in the trade nameor business location of the person or entity on whose behalf this assignment is executed.) ASSIGNOR understands and agrees that by this assignment all right, title and claim to interest in, use of andcontrol over the disposition of the CD is relinquished and that such CDis to be held by the financialinstitution identified to the sole use and subject to the exclusive control of the secretary of state. This CDmay be released only by the secretary of state222s written direction. This is notification by the ASSIGNOR to the financial institution of the terms of this assignment. Date: Signature of authorized person for ASSIGNOR Printed or typed name of authorized person for ASSIGNOR ACKNOWLEDGEMENT BY FINANCIAL INSTITUTION The FINANCIAL INSTITUTION acknowledges the assignment of this CERTIFICATE OF DEPOSIT(223CD224) to the secretary of state. We certify that we have recorded the assignment and have retained a copy. We certify that we do not have, nor do we have knowledge of, anyone else having any lien, encumbrance,right, hold, claim to or obligation of the CD. We accept the CD with knowledge that it has been irrevocably American LegalNet, Inc. www.FormsWorkFlow.com Form 2603 3 posted for and on behalf of the state or any party injured by the auto club222s failure to faithfully perform inselling or providing club services and we agree to act as the sole agent for the purpose of holding thissecurity for the secretary of state222s exclusive use. We agree not to release, make payment, or otherwisedivert or dispose of the CD except in accordance with the written instructions of the secretary of state. It isunderstood that notice to or consent of the ASSIGNOR to disposition of the CD by the secretary of stateshall not be required. We further agree not to exercise any offset rights we may have with respect to this CDor to otherwise impede, hinder, delay, prevent, obstruct or interfere with the secretary of state222s right toredeem and collect this CD promptly. Signature of authorized person for FINANCIAL INSTITUTION Date: Printed or typed name of authorized person for FINANCIAL INSTITUTION RECEIPT FOR SECURITY & DIRECTIONS TO PAY EARNINGS The secretary of state acknowledges receipt of the assignment of the CERTIFICATE OF DEPOSIT (223CD224) for the automobile club identified. The FINANCIAL INSTITUTION is authorized and directed to pay any earnings on the CD to the ASSIGNOR until otherwise notified by mail from the secretary of state. Date: Signature of authorized person for SECRETARY OF STATE Printed or typed name of authorized person for SECRETARY OF STATE American LegalNet, Inc. www.FormsWorkFlow.com