Form Emp-B - Bond Of An Employee Leasing Company And/or Temporary Help Service Company Page 2
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1
2State of Rhode Island and Providence Plantations
Form EMP-B
Employee Leasing and/or Temporary Help Co Bond
STATE OF
COUNTY OF
Personally appeared before me _______________________________________________________
and __________________________________________________ to me known and known to be the
__________________________ and _______________________ of and the persons who executed
the foregoing instrument in behalf of __________________________________, one of the parties to
the foregoing Instrument; and each of them acknowledged said instrument by him signed to be his
free act and deed as such officer and the free act and deed of said ___________________________.
STATE OF
COUNTY OF
Personally appeared before me _______________________________________________________
and __________________________________________________ to me known and known to be the
__________________________ and _______________________ of and the persons who executed
the foregoing instrument in behalf of __________________________________, one of the parties to
the foregoing Instrument; and each of them acknowledged said instrument by him signed to be his
free act and deed as such officer and the free act and deed of said ___________________________.
STATE OF
COUNTY OF
Personally appeared before me _______________________________________________________
and to be the person executing the foregoing instrument as Principal and he acknowledged the same
to be his free act and deed.
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