Form FS Form 2208 FS Form 2208 License Sheet

DEPARTMENT 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.