Free 06732.pdf - Indiana

SURETY BOND RIDER
State Form 6732 (R2 / 6-06) Form SB-2

FOR OFFICIAL USE

Indiana Department of Natural Resources Division of Reclamation
INSTRUCTIONS: Submit one (1) original and (1) copy

This endorsement is to be attached to and form a part of Bond No. Dated , Executed by (Name of Surety) As surety, on behalf of (Name of Permittee) of Indiana, Department of Natural Resources, as oblige, with respect to: Permit Number (Check the appropriate box below)
The amount is (increased) (decreased) by the amount of:

,

, as principal, in favor of the State

Pit Name

.

($) Dollars, ($) Dollars, ($) Dollars,

from the previous amount of: to a new total of: as of the Other: day of , 20 .

Nothing herein contained shall vary, alter or extend any of the provisions, conditions or other terms of this bond except as above stated. WITNESS OUR HANDS AND SEALS THIS day of , 20 .

(Name of Principal) ATTEST: BY: (Signature)

(Typed or printed Name and Title)

(Name of Surety) ATTEST: BY: (Signature) (Attach Power of Attorney)

(Typed or printed Name and Title) ACCEPTED: , 20 Authorized Signature Division of Reclamation Indiana Department of Natural Resources

INSTRUCTIONS FOR COMPLETING FORM SB-2 SURETY BOND RIDER This form may only be used for bonding permanent program permits issued in accordance with I.C. 14-34. Bond for permits issued in accordance with I.C. 14-36-1 must be submitted on a different form. Do not make any entries in the space identified "FOR OFFICIAL USE". The following is explanations of the information that should be entered on the Form SB-2 Surety Bond Rider: (1) (2) (3) (4) (5) (6) Bond No. ­ This number is to be selected and assigned by the surety. Date ­ Insert the date the original bond was executed. Name of Surety ­ Type or print the name of the surety as used on the original surety bond. Name of Permittee ­ Type or print the name of the permittee as used on the original surety bond. Permit Number ­ Type or print the number of the permit as used on the original bond. Pit Name ­ Type or print the name of the mine as used on the original bond.

PLACE AN "X" IN THE BOX BESIDE THE SECTION THAT IS APPLICABLE. (7) BOX 1 ­ This section is to be used only to increase or decrease the current amount of bond. Draw a line through either the word "increased" or "decreased", leaving unmarked that word which describes the changes to be made. (7a) (7b) (7c) (7d) (7e) (7f) (7g) (8) (9) Type or print in words the amount by which the bond is to be increased or decreased. Type or print in numerals the amount in 7a. Type or print in words the previous amount of the bond. Type or print in numerals the amount in 7c. Type or print in words the new total amount of the bond. Type or print in numerals the amount in 7e. Type the date in which the change is executed.

BOX 2 ­ Check this box if Box 1 does not apply. Date ­ Type or print the date on which the bond is executed.

Items (10) through (18) are to be completed as follows: (10) through (13) are to be completed on behalf of the principal. (14) through (16) are to be completed on behalf of the surety. (17) is to be signed by a person witnessing the signature on behalf of the principal, and (18) is to be signed by a person witnessing the signature on behalf of the surety.

Please be sure to submit one (1) original of the fully executed document and one (1) copy. Upon acceptance of the document, one (1) copy will be returned to the surety, and one (1) copy will be sent to the principal.