Motor Fuel Tax Bond Form - North Dakota
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1State Of North Dakota
Office Of State Tax Commissioner
Motor Fuel Tax Bond
Check One Only:
Bond No. ______________________
Motor Vehicle Fuel
Special Fuel
Effective Date __________________
Liquefied Petroleum Gas
Aviation Fuel
Know All Men By These Presents that_____________________________________________________________ of
__________________________________________________ as principal and ____________________________________
______________________________________________ as surety are held and firmly bound unto the state of North Dakota in
the penal sum of __________________________________________ Dollars, ($____________) for payment of which we
jointly and severally bind ourselves, our heirs, administrators, executors and assigns firmly by these presents.
The condition of this bond is such that:
Whereas, pursuant to North Dakota Century Code chs. 57-43.1, 57-43.2 and 57-43.3, the Tax Commissioner of the
state of North Dakota is empowered to require a bond from any person holding a valid fuel tax license or seeking a fuel tax
license in the state of North Dakota.
Now, Therefore, if the principal performs the obligation to file reports and pay Motor Vehicle Fuel, Special Fuels,
Liquefied Petroleum Gas, or Aviation Fuel taxes as required by statute and by the duly promulgated rules and regulations of the
Tax Commissioner of the state of North Dakota, this obligation shall be null and void, otherwise it shall be in full force and
effect. It being understood and agreed, however, that if the surety shall so elect, this bond may be cancelled at any time by
serving thirty days written notice (by registered or certified mail) on the principal and the state Tax Commissioner.
Sworn and subscribed to as follows on ______________________________________:
Month
Day
Year
Principal
________________________________________________
Name (Business, Corporate, or Legal) of Principal
Notary Public for State of _________________________
________________________________________________
Street Address or Post Office Box No.
My Commission Expires __________________________
________________________________________________
City
State
Zip Code
______________________________________________
________________________________________________
Notary Public for Principal
Authorized Signature and Title for Principal
Surety
________________________________________________
Name (Business, Corporate, or Legal) of Surety Co.
Notary Public for State of _________________________
________________________________________________
Street Address or Post Office Box No.
My Commission Expires __________________________
________________________________________________
City
State
Zip Code
_______________________________________________
________________________________________________
Notary Public for Surety
Authorized Signature for Surety
(Surety Seal)
22979
(6-1999)
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