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X-471 KNOW ALL MEN BY THESE PRESENTS: as suret__, are held and firmly bound unto the UNITED STATES OF AMERICA in the full and just sum of __________________________ _______________ _ dollars ($_____________ ) lawful money of the United States; for which payment, well and truly to be made we bind ourselves, jointly and severally, our joint and several heirs, executors, and administrators, successors and assigns, firmly by these presentsSealed with our seals, and dated this ____________ day of _____________ , in the year .one thousand nine hundred and _____ , The condition of the above obligation is such, That whereas under authority of an Act of Congress approved ____ . ___________ _______ , 19.17, the said ___________________________________ _ _ has filed an application with the Secretary of the Treasury, through the Federal Reserve Board, for a license to export the sum of $________________________ in gold to _________________ to be used for the following purposes: X-471 - 2 WHEREAS, upon the recommendation of the Federal Reserve Board, the Secretary of the Treasury has authorised the issuance of such license, upon the condition, however, that the applicant shall file with the Federal Reserve Board a bond running to the United States in the penal sum of $__________________________ executed by the applicant as principal and by a surety approved by the Federal ReseiVe Board and abnditionsd upon the submission to the Federal Reserve Board within ninety days from date of sat isfactory evidence that said gold has been used for the purposes above enumerated in tfye application. NCW, THEREFORE, if the said ___________________________ _ _ _________________ shall, within ninety days from date, furnish to the Federal Reserve Board through the Federal Reserve Bank sat isfactory evidence that the gold exported under the license refer red to has been used for the purposes indicated in the application and above set forth and for no other purposes, such evidence to be in the following form,to wit: • Then this bond shall be void and of none effect, otherwise it shall remain in full force and effect. Signed, sealed and delivered in the presence of - '