Assignment Of Certificate Of Deposit As Security Page 2

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STATE OF ___________________
COUNTY OF_________________
Sworn to and subscribed before me on the _________ day of __________________________,
__________.
____________________________________
Notary Public Signature
Seal
____________________________________
Printed Name of Notary Public
My Commission Expires _____________
<<<<<<<<<<<>>>>>>>>
The Financial Institution named herein acknowledges this assignment.
_________________________________
_______________________
Signature of Officer
Date
_________________________________
Printed Name & Title
<<<<<<<<<<<<<<<>>>>>>>>>>>>>>>
RECEIPT OF SECURITY AND DIRECTION TO PAY EARNINGS
Receipt is acknowledged of the above assignment. The financial institution is hereby
authorized and directed to pay any earnings from the C.D. to the assignor.
DATE:_____________________________
________________________________________
Signature
(for the Secretary of State)
________________________________________ ___________________
(Printed Name)
(Title)

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