County of Enter the county of the providerâs/applicantâs physical address. State of Enter the state of the providerâs/applicantâs physical address. Surety Name Enter the name of the surety company issuing the bond. State of Enter the state in which the surety company is incorporated. Surety Address Enter the business address of the issuing surety company. City of Enter the city of the surety companyâs business address.