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Free Promissory Note Template - PDF

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					                                FEDERAL COMMUNICATIONS COMMISSION
                                         Washington, DC 20554

                                                    SURETY BOND

       KNOW ALL MEN BY THESE PRESENTS, THAT THE UNDERSIGNED
_________________________________________________________________,
                                  (Corporation/Permittee/Obligor)

_______________________(City) ____________________ (State) _______(ZIP) a corporation organized and
existing under the laws of the State of ____________, as Principal and
_______________________________________________________________,1 organized and existing
                  (Name and Address of Surety Company)
under the law of the State of _____________ and licensed to do business in the State of ________________, as
Surety, are held and firmly bound unto the Federal Communications Commission (FCC) in the sum of
_____________________ DOLLARS ($_________________ ), to be paid to the said FCC or its successors for
which payment well and truly to be made we bind ourselves and successors formally by these presents.

         THE CONDITIONS OF THE ABOVE OBLIGATION is such, that:

         Whereas, the above-named Principal is indebted to the United States for the underpayment of Universal
Service Fund contributions made to the Universal Service Administrative Company on behalf of the FCC in the
amount of _____________ DOLLARS ($_______________) (Principal Debt); and

        Whereas, the above-named Principal has requested that it be allowed to remit the Principal Debt using a
Deferred Payment Plan accompanied by a certain Promissory Note and Security Agreement (Loan Documents(s));
and

          Whereas, the Principal has voluntarily offered as an inducement to the extension of credit by the United
States a guarantee of the obligation;

         Whereas, the Surety, and its successors and assigns agree to guarantee the obligation and to indemnify,
defend, and hold harmless the FCC (and the United States) from any and all losses and expenses which the FCC
may sustain as a result of the Principal’s failure to comply and or all condition(s) of the Deferred Payment Plan
and/or Loan Documents;

         Whereas obligations guaranteed by this bond shall be in effect for the term of the Promissory Note until
such time as the terms of the Deferred Payment Plan and/or Loan Documents have been satisfactory completed by
the Principal and the FCC has discharged the obligation;

         Now, if the above bounden Principal shall well, truly, and faithfully pay or cause to be paid unto the said
FCC, it successors or assigns, the full sum of __________ DOLLARS ($_______) in the manner following:

         (a)          beginning on the effective date of the Promissory Note and extending until the debt has been
                      repaid in full;
         (b)          until the bond is released or replaced; and
         (c)          the sum of ________ DOLLARS, monthly throughout each calendar year on the 15th day of
                      each month, together with interest in each case at the rate specified in the Deferred Payment
                      Plan and/or Loan Documents on the whole sum remaining due at the time of each payment.




1
 Said Surety is on the Secretary of the Treasury’s Listing of Approved Sureties (Department Circular 570), and it
complies with 31 U.S.C. 9304-9308 and meets the requirements of 31 CFR Part 223.
                                                          1
                                                                                           Bond No. __________
          Then this obligation shall be void and of no effect; and otherwise shall remain in full force. The failure of
the Principal to fulfill the obligations set forth in the Deferred Payment Plan and Loan Documents shall result in a
forfeiture of this Surety Bond.

        The Surety shall not cancel this bond at any time for any reason, including non-payment of premium or
bankruptcy of the Principal during the period of liability. The amount of the Surety’s liability may be adjusted by
the FCC, upon application by the Principal for revision of the bond amount.

          The Surety will give prompt notice to the Principal and to the FCC of any notice received or action filed
alleging the insolvency or bankruptcy of the Surety, or alleging any violations of regulatory requirements that could
result in suspension or revocation of the Surety’s license to do business.

         In the event the Surety becomes unable to fulfill its obligations under the bond for any reason, notice shall
be given immediately to the Principal and to the FCC.

           Upon incapacity of the Surety by reason of bankruptcy, liquidation, insolvency, or suspension or revocation
of its license, the Principal shall be deemed to be without bond coverage, and subject to enforcement actions
described in the Loan Documents.

          IN WITNESS WHEREOF, the Principal and Surety have hereunto set their signatures and seals as of the
dates set forth below.

                                                     PRINCIPAL

         Date_____________________                ______________________________
                                                              (Corporation/Principal)
(Affix Seal)                                            By: __________________________
                                                              (Corporate Officer)2

                          ACKNOWLEDGEMENT OF CORPORATION-PRINCIPAL

          On this ______ day of _________, 20__, before me, a Notary Public in and for the County of _______, in
the State of _______________, appeared ___________________ to me personally known who, being by me fully
sworn, did say that he/she is __________________ ______________ of ___________________________, the
corporation named in and which executed the within instrument, and that the seal affixed to said instrument is the
corporate seal of said corporation, and that said instrument was signed, sealed and delivered in behalf of said
corporation by authority of its Board of Directors, and he/she, as such officer, acknowledged said instrument to be
the free act and deed of said corporation for the uses and purposes of said instrument as therein set forth.

         IN WITNESS WHEREOF, I have hereunto set my hand and official seal on the day, month, and year
aforesaid.

My Commission Expires:                                 _____________________________
                                                       Notary Public in and for said County and State

                                                       SURETY

         Date_____________________                ______________________________
                                                              (Corporate Surety)
(Affix Seal)                                            By: __________________________



2
 Where one signs by virtue of Power of Attorney or Corporate Resolution for a corporate Principal, such certified
Power of Attorney or Corporate Resolution must be filled with this bond.

                                                           2
                                                                                            Bond No. __________
                                                       Title: _________________________
                                                                (Attorney-in-Fact)3

                            ACKNOWLEDGEMENT OF CORPORATE SURETY

          On this ______ day of _________, 20__, before me, a Notary Public in and for the County of _______, in
the State of _______________, appeared ___________________ to me personally known who, being by me fully
sworn, did say that he/she is __________________ ______________ of ___________________________, the
corporate Surety named in and which executed the within instrument, and that the seal affixed to said instrument is
the corporate seal of said corporation, and that said instrument was signed, sealed and delivered in behalf of said
corporation by authority of its Board of Directors, and he/she, as such officer, acknowledged said instrument to be
the free act and deed of said corporation for the uses and purposes of said instrument as therein set forth.

         IN WITNESS WHEREOF, I have hereunto set my hand and official seal on the day, month, and year
aforesaid.

My Commission Expires:                               _____________________________
                                                     Notary Public in and for said County and State




3
 If applicable, insert here the name, address, voice and facsimile telephone number and e-mail address of the
Agency representing the Surety Company: ________________________, __________________, ______
____________, ______________________________________________.




                                                         3
                                                                                         Bond No. __________
                               FEDERAL COMMUNICATIONS COMMISSION
                                        Washington, DC 20554

                                 SURETY BOND GENERAL PURPOSE RIDER

Bond No. ________

       To be attached to and form part of Surety Company Bond No. __________________ written by
___________________________________ AS SURETY, on behalf of
____________________________________________AS PRINCIPAL, in the sum of
____________________________ DOLLARS ($________________), in favor of the Federal Communications
Commission and executed on ________________ (date).

         Whereas, the FCC [                                        ]

         Whereas, said bond and rider shall cover [     ] since the [        ];

Now, therefore, the purpose of this rider is: [                              ]




         It is further understood and agreed that all other terms and conditions of this Bond shall remain unchanged.
                                                      PRINCIPAL

        Signed and executed this ________ day of _________, 20 _____.
BY: ____________________________
                                                                  (Affix Seal)
TITLE:1 ________________________

State of _________________________ )
                                   ) SS.
County of _______________________ )

                                              ACKNOWLEDGMENT

The foregoing instrument was acknowledged before me by ____________________ this _______day of
_______________________, __________.

Witness my hand and official seal: ________________________________________
                                           (Notary Public or other authorized officer)
                                           My Commission expires: __________________

                                                      SURETY

       Signed and executed this ________ day of _________, 20 _____.
BY: ____________________________
                                                                 (Affix Seal)

1
 Where one signs by virtue of a Corporate Resolution or Power of Attorney for a Corporate Principal or the Surety
Company, such certified Power of Attorney or Corporate Resolution must be filed with and made a part of this
Rider.
                                                          1
                                                                                          Bond No. __________
TITLE:2 ________________________

State of _________________________ )
                                   ) SS.
County of _______________________ )

                                             ACKNOWLEDGMENT

The foregoing instrument was acknowledged before me by ____________________ this _______day of
_______________________, __________.

Witness my hand and official seal: ________________________________________
                                           (Notary Public or other authorized officer)
                                           My Commission expires: __________________




2
 Where one signs by virtue of a Corporate Resolution or Power of Attorney for a Corporate Principal or the Surety
Company, such certified Power of Attorney or Corporate Resolution must be filed with and made a part of this
Rider.




                                                        2
                                                                                       Bond No. __________
                              FEDERAL COMMUNICATIONS COMMISSION
                                       Washington, DC 20554

                              SURETY BOND INCREASE/DECREASE RIDER

Bond No.__________

       To be attached to and form part of Surety Company Bond No. __________________ written by
___________________________________ AS SURETY, on behalf of
____________________________________________AS PRINCIPAL, in the sum of
____________________________ DOLLARS ($________________), in favor of the Federal Communications
Commission and executed on ________________ (date).

        Whereas, the FCC [                                         ]

        Whereas, said bond and rider shall cover [      ] since the [       ];

        Now, therefore, the amount of the bond is (increased/decreased) by
__________________________________DOLLARS ($ _________________) to a total sum of
__________________________________DOLLARS ($____________________), to cover the (additional/reduced)
amount of the [secured amount, principal debt].

        It is further understood and agreed that all other terms and conditions of this Bond shall remain unchanged.

                                                     PRINCIPAL

        Signed and executed this ________ day of _________, 20 _____.
BY: ____________________________
                                                                  (Affix Seal)
TITLE:1 ________________________

State of _________________________ )
                                   ) SS.
County of _______________________ )

                                             ACKNOWLEDGMENT

The foregoing instrument was acknowledged before me by ____________________ this ___day of _______, 20__.

Witness my hand and official seal: ________________________________________
                                           (Notary Public or other authorized officer)
                                           My Commission expires: __________________

                                                      SURETY

        Signed and executed this ________ day of _________, 20 _____.
BY: ____________________________
                                                                  (Affix Seal)
TITLE:2 ________________________




1
 Where one signs by virtue of a Corporate Resolution or Power of Attorney for a Corporate Principal or the Surety
Company, such certified Power of Attorney or Corporate Resolution must be filed with and made a part of this
Rider.
                                                         1
                                                                                         Bond No. __________
State of _________________________ )
                                   ) SS.
County of _______________________ )

                                             ACKNOWLEDGMENT

The foregoing instrument was acknowledged before me by ____________________ this __day of ______, 20___.
Witness my hand and official seal: ________________________________________
                                           (Notary Public or other authorized officer)
                                           My Commission expires: __________________




2
 Where one signs by virtue of a Corporate Resolution or Power of Attorney for a Corporate Principal or the Surety
Company, such certified Power of Attorney or Corporate Resolution must be filed with and made a part of this
Rider.
                                                        2
                                                                                       Bond No. __________

				
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