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pdfDEPARTMENT OF THE TREASURY
BUREAU OF THE FISCAL SERVICE
HYATTSVILLE, MD 20782
OMB 1530-0009
*** LICENSE SHEET ***
Name of Company
State Of Incorporation
NAIC Company Code
NAIC Group Code
Contact Name
Contact Title
Contact Phone Number
Contact E-Mail
Date
Please indicate by an (X) the states and other areas in which your company is licensed to transact SURETY business as a DIRECT
WRITER. NOTE: If any restrictions have been imposed by states checked, include an explanation on an attached sheet. The
explanation should include the type, reason for and time period of the imposed restriction.
AL Alabama
KY Kentucky
OH Ohio
AK Alaska
LA Louisiana
OK Oklahoma
AS Am. Samoa
ME Maine
OR Oregon
AZ Arizona
MD Maryland
PA Pennsylvania
AR Arkansas
MA Massachusetts
PR Puerto Rico
CA California
MI
RI
CO Colorado
MN Minnesota
SC South Carolina
CT Connecticut
MS Mississippi
SD South Dakota
DE Delaware
MO Missouri
TN Tennessee
DC District of Columbia
MP Northern Mariana Islands
TX Texas
FL Florida
MT Montana
UT Utah
GA Georgia
NE Nebraska
VT Vermont
GU Guam
NV Nevada
VA Virginia
HI
Hawaii
NH New Hampshire
VI
ID
Idaho
NJ New Jersey
WA Washington
IL
Illinois
NM New Mexico
WV West Virginia
IN
Indiana
NY New York
WI
IA
Iowa
NC North Carolina
WY Wyoming
KS Kansas
Michigan
Rhode Island
Virgin Islands
Wisconsin
ND North Dakota
FOR TREASURY DEPT. USE ONLY
SIMS AUTH. NEEDED: YES/NO
INPUT
AUTH. COMPLETED
INIT.
DATE
FS FORM 2208 (10-2015)
Previous editions of FMS Form 2208 are obsolete.
File Type | application/pdf |
Author | Caron Carroll |
File Modified | 2015-10-21 |
File Created | 2013-01-17 |