Form 4-995.1. Corporate surety statement.

[For use with Rule 1-140 NMRA] STATE OF NEW MEXICO COUNTY OF _______________ __________________ JUDICIAL DISTRICT In the matter of _______________________________, No. __________ a Protected Person. CORPORATE SURETY STATEMENT We, ___________________________________________________________, acting as Corporate Surety in the above referenced matter, under Section 45-5-411 NMSA 1978, hereby submit the following statement to the Court: By the execution of this Statement, we acknowledge that we are Surety on the bond set by the Court in this matter, and that the bond amount is $_____________________________. We further state that the bond is in force for the next annual period, and will remain in effect until we are discharged by further order of the Court. We will notify the Court of any failure to pay premiums, as required by Section 45-5- 411 NMSA 1978. The bond’s current expiration date is _____________________________________. This ____________ day of ___________________________________, 20_______. SIGNATURE OF SURETY: ______________________________________ NAME OF CORPORATE SURETY: ______________________________________ ADDRESS: ______________________________________ ______________________________________ ______________________________________ ______________________________________