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Form Wv/sev-Nrt-Bond 1 - Nonresident Timber Severance Tax Prepayment Cash Bond - 1999

WV/SEV-NRT-Bond 1

West Virginia

Original 1/99

State Tax Department

NONRESIDENT TIMBER SEVERANCE TAX

PREPAYMENT CASH BOND

BOND NUMBER

FEIN OR SOCIAL SECURITY NUMBER:

BUSINESS NAME:

OWNER(S) NAME:

ADDRESS:

Pursuant to W. Va. Code § 11-13A-16a, the above named nonresident is posting a cash prepayment/bond to guarantee

payment of the West Virginia Timber Severance Tax with respect to the attached Timber Operation Notification Form filed

with the Division of Forestry.

Estimated gross value of the timber described in the Timber Operation Notification Form filed with the Division of Forestry

$______________________. The value should not be less than the actual price paid, or to be paid, for the stumpage.

The amount of the cash bond/prepayment must be equal to four percent (4%) of the estimated gross value of the timber

described in the Notification for which the bond is being posted. The above named nonresident harvester hereby posts the amount

of $___________________ as cash bond/prepayment with respect to the described timbering operation and certifies that this

amount represents four percent (4%) of the approximate gross value of the timber to be harvested and will be sufficient to cover

the timber severance taxes due with respect to the referenced timber operation.

This bond shall be effective from _________________, 19___.

In witness whereof the above named nonresident hereby executes this instrument this ____ day of _____________, 19____.

(Authorized Officer or Agent Nonresident)

Acknowledged before me this ____day of _____________, 19____.

My commission expires __________________________________.

Notary Seal

Notary Signature

DO NOT USE THIS SPACE

Form Wv/sev-Nrt-Bond 1 - Nonresident Timber Severance Tax Prepayment Cash Bond - 1999