SURETY DISCLOSURE STATEMENT AND CERTIFICATION
.............................., surety(ies) on the attached bond, hereby certifies(y) the following:
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CERTIFICATE
(to be completed by an authorized certifying agent
for each surety on the bond)
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(Signature of certifying agent)
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(Printed name of certifying agent)
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(Title of certifying agent)
N.J.S. § 2A:44-143