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• <br />[FORM OF STATEMENT OF INSURANCE] <br />STATEMENT OF INSURANCE <br />Municipal Bond Guaranty Insurance Policy No. (the "Policy") with respect to payments due for <br />principal of and interest on this Bond has been issued by AMBAC Indemnity Corporation ("AMBAC Indemnity"). <br />The Policy has been delivered to the United States Trust Company of New York, New York, New York, as the <br />Insurance Trustee under said Policy and will be held by such Insurance Trustee or any successor insurance trustee. <br />The Policy is on file and available for inspection at the principal office of the Insurance Trustee and a copy thereof <br />may be secured from AMBAC Indemnity or the Insurance Trustee. All payments required to be made under the <br />Policy shall be made in accordance with the provisions thereof. The owner of this Bond acknowledges and consents <br />to the subrogation rights of AMBAC Indemnity as more fully set forth in the Policy. <br />[FORM OF ASSIGNMENT] <br />ASSIGNMENT <br />FOR VALUE RECEIVED, the undersigned hereby sells, assigns, and transfers unto <br />(Please insert Social Security Number or (Please print name and address, including zip code, of Transferee) <br />Taxpayer Identification of Transferee) <br />the within Bond and all rights thereunder, and hereby irrevocably constitutes and appoints _ <br />attorney to register the transfer of <br />the within Bond on the books kept for registration thereof, with full power of substitution in the premises. <br />Dated: <br />Signature Guaranteed: <br />NOTICE: Signature(s) must be guaranteed by a <br />member firm of the New York Stock Exchange <br />or a commercial bank or trust company. <br />NOTICE: The signature above must correspond <br />with the name of the Registered Owner as it <br />appears upon the front of this Bond in every <br />particular, without alteration or enlargement <br />or any change whatsoever. <br />The following abbreviations, when used in the Assignment above or on the face of the within Bond, shall be <br />construed as though they were written out in full according to applicable laws or regulations: <br />TEN COM - as tenants in common <br />TEN ENT - as tenants by the entireties <br />JT TEN - as joint tenants with right of survivorship and not as tenants in common <br />UNIF GIFT MIN ACT - Custodian <br />(Gust) (Minor) <br />under Uniform Gifts to Minors Act <br />(State) <br />Additional abbreviations may also be used though not in the list above. <br />9 <br />