Know all men by these presents: That we, A. B., of ---------, ---------, as principal, and X. Y., of---------,---------, as surety, are held and firmly bound unto

C. D., of--------- in the sum of --------- dollars, to be paid to the said C. D., his heirs, executors, administrators or assigns, to which payment, well and truly to be made, we bind ourselves, our heirs, executors and administrators, firmly by these presents.

The condition of this obligation is such, that whereas the said A. B. has, by an instrument in writing of even date herewith, promised and agreed to pay unto the said C. D., in each and every month during the lifetime of said E. F., the sum of---------dollars ($---------) in monthly payments to begin on the-------day of---------, A. D. 19-, and subsequent payments to be made monthly thereafter so long as the said C. D. shall live, the last payment to be such pro rata amount as shall have accrued to the time of the death of said . F. from the time of payment next preceding, and to be paid to said E. F., his administrators, executors or assigns:

Now if the said A. B., his heirs, executors or administrators, shall well and truly pay, or cause to be paid, all of said amounts at the time the same become due and payable, then the foregoing obligation shall be void; otherwise the same shall remain in full force and effect.

In witness whereof, etc.

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For form of contract for annuity, see 5 3774.