Surface Mining And Reclamation Section - Tennessee Department Of Health And Environment Page 2

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BOND NO. ____________________
APPLICATION NO. ____________________
-2-
(b) give immediate notice to the Principal and the Section in the event the
Surety becomes unable to fulfill its obligations under this instrument.
Upon the incapacity of the Surety by reason of bankruptcy, insolvency or
suspension or revocation of its license, the permittee shall be deemed to be without
bond coverage in violation of T.C.A. 59-8-205 and T.C.A. 59-8-207, and shall
discontinue surface mining operations until new performance bond coverage is
approved.
In the event of forfeiture, the amount of this obligation shall be confessed to
judgement.
__________________________________
__________________________________________
Principal
Date
BY _______________________________
__________________________________________
Signature
Title
STATE OF _________________________
COUNTY OF ________________________
Sworn to and subscribed before me this ______ day of _____________, _______
_______________________________
NOTARY PUBLIC
COMMISSION EXPIRES: ______________________________
_____________________________________ By _______________________________________
Surety
_____________________________________
________________________________________
Address
Title
________________________________________
Date
STATE OF _________________________
COUNTY OF ________________________
Sworn to and subscribed before me this ______ day of _____________, _______
_______________________________
NOTARY PUBLIC
COMMISSION EXPIRES: ______________________________
(Attach Power of Attorney for Surety Signatory)

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