FORM OF REPORT REQUIRED OF CANAL COMPANIES.-PP. 52, 53.

Report for the year 187-, of the

canal company, Virginia, showing the esti

mated value of its real and personal property of every description, taxed at fifty cents on the $100 value thereof, as of the first day of February, 187-, made in pursuance of the act imposing taxes on canal companies, &c., approved March 13,

FORM OF REPORT OF GROSS RECEIPTS OF CANAL COMPANIES. PP. 52, 53.

Report of the gross and net receipts of the

canal company in the commonwealth of Virginia, for the year ending February 1, 187-, made in pursuance of the act imposing taxes on railroad companies, &c., approved March 13, 1877.

Entire length of the canal in Virginia..................................
Proportion the length of the canal in Virginia
bears to the entire length of the canal.........
Apportionment of income to length of canal in Virginia.....

FORM OF POWER OF ATTORNEY APPOINTING AN AGENT OF A FOREIGN INSURANCE COMPANY IN VIRGINIA.

Know all men by these presents, That the

in the state of

insurance company, located in the city of have authorized and appointed for themselves and their successors, the following persons, to-wit: of the city of ——, and state of Virginia, to transact in the name and in behalf of said company, under instructions as agent of said company, the business of life insurance in the state of Virginia. And the said company doth hereby appoint the said

their lawful attorney, for them and in their behalf, to except service of legal process for said company; expressly consenting that service of process upon such, our attorney, shall be taken and held to be valid, as if served upon said company according to the laws of this state or any other state, and waving all claim of error by reason of said process.

In witness whereof, the said, the

insurance company,

have hereunto affixed their corporate seal, attested by the official signature of the president and [SEAL.] Secretary thereof, at

this, the

eight hundred and seventy

day of

one thousand

President.
Secretary.

STATE OF

City and County of

Be it remembered, that on the

said, before me,

a commissioner, resident in said city, duly commissioned and qualified by the executive authority, and under the laws of the state of Virginia to take acknowledgment of deeds, &c., to be used or recorded therein, per

who are personally known to me to be the individuals they purport to be, described in, and who executed the annexed instrument, bearing date the 187, being a power of attorney appointing Virginia, agent of said

insurance company in the

state of Virginia.

And the said

and

then and there acknowledged to me

that they executed the same as their free act and deed, and for the uses and purposes therein expressed, and therefore wished it certified and recorded; and being duly sworn, say that the seal attached is the seal of the company, and is attached as such. In testimony whereof, I have hereunto set my hand, and affixed the seal of our office, on the

FORM OF BOND OF AGENT OF FOREIGN INSURANCE COMPANY.

Know all men by these presents, That we, " principal, and and sureties, are held and firmly bound unto the commonwealth of Virginia, in the sum of one thousand dollars; to which payment we bind ourselves, our and each of our heirs, executors, and administrators, jointly and severally, firmly by these presents. Sealed with our seals, and dated the

as

day of

The condition of the above obligation is such, that whereas an insurance company, not incorporated by the legislature of the state of Virginia, denominated and known insurance company," located at the city of in the state of desires to make contracts of insurance in said state of Virginia, and has, by written power of attorney, appointed of a citizen of the state of Vir

ginia, resident therein, its agent to accept service of all lawful processes against such company in this commonwealth, and to cause an appearance to be entered in any action, in like manner as if such corporation had existed and been duly served with a process in this state.

And whereas a copy of such power of attorney, duly certified and authenticated, has been filed with the auditor of public accounts of the commonwealth of Virginia: Now, if the said company, by the said -, acting as agent aforesaid in this state, shall, between the first and fifteenth days of January in every year, during ' the continuance of the said insurance agency, make a return on oath of said agent, to the auditor of public accounts, of the gross amount of all assessments or of premiums collected or received, or obligation taken therefor, by such company from its business in the state of Virginia, for the twelve months preceding the said first day of January, and shall, at the same time, pay into the treasury such tax as may be imposed by law on the amount of such premiums and assessments—then the above obligation to be void, else to remain in full force and virtue.

[SEAL.]

[SEAL.]

[SEAL.]

VIRGINIA,
I,

City, to-wit:

ginia, do certify that

a notary public for the city aforesaid, in the state of Virprincipal,

and

sureties, whose names are signed to the writing hereunto annexed, bearing date on 187, have acknowledged the same before me, in my city

day of

the aforesaid.

And I further certify, that the securities offered, and whose names are signed to the annexed bond, are, in my opinion, amply sufficient, and able to pay the penalty thereof.

FORMS OF TREASURER'S CERTIFICATE OF THE BONDS DEPOSITED.

Schedule of securities deposited with the treasurer of Virginia, in conformity with insurance laws of said state, by the insurance company, of

I certify that the above described securities are deposited with me by the insurance company of

Treasurer of Virginia.

COMMONWEALTH OF VIRGINIA,
TREASURER'S OFFICE,
RICHMOND,

I hereby certify that the bonds required to be deposited by the

company of the city of

in the state of

under the provisions of the

laws of this state requiring a deposit of securities to be made by foreign insurance companies doing business in this state, are in my possession.

To the Auditor of Public Accounts for the Commonwealth of Virginia :

This is to certify that the

the state of has complied with the laws of this commonwealth requiring a deposit of securities to be made with the treasurer of the commonwealth by foreign insurance companies doing business in this state.

R. M. T. HUNTER, Treasurer of the Commonwealth of Virginia.