Warren-Forest Court of Common Pleas Thirty Seventh Judicial District
of the Commonwealth of Pennsylvania

1. No corporation shall be accepted as surety upon any bond to be approved by the Court unless such corporation has filed in the office of the Prothonotary of the County of the District a certificate issued by the Insurance Commissioner of the Commonwealth authorizing it to become surety on bonds, obligations and undertakings and certifying that such certificate has not been revoked by the Insurance Commissioner.

2. In all cases where surety other than a corporation is required to be approved by the court for bonding purposes, the individual offering the surety for approval shall execute an affidavit in the following form which shall be provided by the Prothonotary.

        COMMONWEALTH OF PENNSYLVANIA
          County of Warren/Forest
                                            SS:
	The undersigned, being considered as a proper surety in the above
entitled case and being duly sworn according to law, deposes and states:
  1.  My (our) full post office address is:
________________________________________________
________________________________________________
________________________________________________
  2.  I (we) own real estate in Warren/Forest County, Pennsylvania, in fee
simple in my (our) name(s) having a fair market value of at least
$____________________.
  3.  That attached hereto is the appraisal of a licensed real estate
appraiser within the Commonwealth of Pennsylvania/or certified copy of the
County tax assessment record.
  4.  That attached hereto is the certificate of an attorney of all
recorded liens against the said realty.
  5.  The real estate is recorded in my (our) name(s) in Warren/Forest
County Deed Book/Record Book  Vol.____________,Page____________.

_________________________________
Signature


Sworn and subscribed to me this 
______day of___________,_____.

______________________________