Assignemnt of Certificate of Deposite for Collateral Bon

United States Department of the Interior
OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT
ASSIGNMENT OF CERTIFICATE OF DEPOSIT FOR COLLATERAL BOND
(Corporation)

WHEREAS, on the _______day of _______________________________, ________
___________________________________________________________________________
(Name of Corporation – Permittee)

___________________________________________________________________________
(Address, City, State, Zip Code)

executed (a) certain Certificate(s) of Deposit described as follows:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
to secure performance of certain reclamation under Surface Coal Mining Permit No.
__________________.
WHEREAS, under 30 CFR §800.21(a)(3) the permittee is required to post an acceptable
new certificate or provide an executed assignment of the existing certificate made payable to the
regulatory authority.
NOW THEREFORE, to satisfy the requirements of 30 CFR §800.21(a)(3), the
undersigned ______________________________________ as Obligor, hereby assigns its
(Name of Corporation – Permittee)

interest in the Certificate(s) of Deposit as described above, made payable to the “United States
Department of the Interior, Office of Surface Mining Reclamation and Enforcement.”
THE CONDITION OF THE ABOVE ASSIGNMENT is such that the certificate shall:
(a)

be assigned to the United States Department of the Interior, Office of Surface
Mining Reclamation and Enforcement, both in writing and upon the books of the
institution issuing such certificates;

(b)

individually not exceed $100,000 or the maximum insurable amount as
determined by F.D.I.C and F.S.L.I.C.;

(c)

be conditioned upon the Issuing Institution waiving all rights of set-off or liens
which it has or may have against such certificates;

Permit No.__________

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Certificate of Deposit - Corporation

(d)

be deposited in sufficient amounts, so that liquidation of those certificates prior to
maturity would provide the required bond amount;

(e)

the assignment shall remain in full force and effect until released in writing by the
Office of Surface Mining Reclamation and Enforcement.

This assignment shall be valid throughout any maturity redemption period as designated
by the Issuing Institution, and shall also automatically renew itself when the Certificate(s) of
Deposit is renewed.
IN WITNESS WHEREOF, the Obligor has hereunto set its signature and seal this
______ day of _____________________, _______.
___________________________________
(Corporation-Permittee)

By:________________________________
(Corporate Officer)

Title:_______________________________

IN WITNESS WHEREOF, the Issuing Institution has hereunto set its signature and seal
this___________ day of _______________________________,________.
____________________________________
(Issuing Institution)

By:_________________________________
Title:_______________________________

ACKNOWLEDGEMENT OF CORPORATION – PERMITTEE
On this __________ day of ______________________, ___________, before me, a
Notary Public in and for the County of ______________________________, in the State of
__________________, appeared ________________________________, to me personally
known who, being by me duly 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 corporation 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.

Permit No.__________

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Certificate of Deposit - Corporation

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 aforesaid County and State)

ACKNOWLEDGEMENT OF ISSUING INSTITUTION
On this __________ day of ______________________, ___________, before me, a
Notary Public in and for the County of ______________________________, in the State of
___________________________, appeared ________________________________, to me
personally known who, being by me duly sworn, did say that he/she is _____________________
of ___________________________________, the Issuing Institution named in and which
executed the within instrument, and that the seal affixed to said instrument is the corporation seal
of said Issuing Institution, 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 aforesaid County and State)

Paperwork Reduction Act Notice
We use the information required by this form to ensure that the requirements for a collateral bond under 30 CFR
800.21 have been met. You must provide the requested information to obtain a benefit (a collateral bond that relies
upon certificates of deposit). Under 30 CFR 842.16, the information collected is a matter of public record.
The time needed to complete this form and related forms and submit the requested information to obtain a collateral
bond will vary depending on individual circumstances. We estimate that the average time will be 10 hours per
response. This number includes the time spent reviewing instructions, learning about the regulations, gathering and
maintaining information, and completing and reviewing the forms. If you have comments concerning the accuracy
of this estimate or suggestions for simplifying the forms or instructions, you may write to the Information Collection
Clearance Officer, Office of Surface Mining Reclamation and Enforcement, Room 202 SIB, 1951 Constitution Ave,
NW, Washington, D.C. 20240.
Under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.), you are not required to respond to, nor will
you be subject to a penalty for a failure to comply with, a collection of information unless it displays a currently
valid OMB control number.
OMB Control No. 1029-0043; expires 9/30/2015

Permit No.__________

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Certificate of Deposit - Corporation