Form Rt 133 - Motor Fuel Distributor Bond Form - Departament Of Safety Road Toll Bureau, State Of New Hampshire

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No.________________
STATE OF NEW HAMPSHIRE
DEPARTMENT OF SAFETY
ROAD TOLL BUREAU
MOTOR FUEL DISTRIBUTOR BOND FORM
(PLEASE COMPLETE BOTH SIDES)
KNOW ALL MEN BY THESE PRESENTS, THAT WE (Motor Fuel Distributor):
Name:___________________________________________________
Address:_________________________________________________
City, State Zip: ____________________________________________
AS PRINCIPAL, AND THE (Surety):
Name:___________________________________________________
Address:_________________________________________________
City, State Zip: ____________________________________________
A CORPORATION DULY ORGANIZED UNDER THE LAWS OF THE STATE OF ___________ AND LICENSED TO DO
BUSINESS IN THE STATE OF NEW HAMPSHIRE AS SURETY, ARE HELD AND FIRMLY BOUND UNTO THE STATE
OF NEW HAMPSHIRE, AS OBLIGEE, IN THE SUM OF $__________________DOLLARS FOR THE PAYMENT OF
WHICH, WELL AND TRULY TO BE MADE, WE JOINTLY AND SEVERALLY, BIND OURSELVES. OUR HEIRS,
EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS BY THESE PRESENTS.
SIGNED, SEALED, AND DELIVERED THIS _____DAY OF ___________2_____.
WHEREAS, THE SAID PRINCIPAL HAS MADE APPLICATION TO THE ROAD TOLL BUREAU OF THE
STATE OF NEW HAMPSHIRE FOR A LICENSE TO ENGAGE IN THE BUSINESS AS A DISTRIBUTOR OF MOTOR FUELS,
AS PROVIDED IN CHAPTER 260 NH REVISED STATUTES ANNOTATED 1955 AS AMENDED.
NOW THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH THAT IF SAID PRINCIPAL AS
SUCH LICENSEE SHALL PROMPTLY FILE TRUE REPORTS AND MAKE PAYMENT OF ALL MOTOR VEHICLE ROAD
TOLLS, TOGETHER WITH ALL PENALTIES AND INTEREST THEREON, WHICH ARE IMPOSED UPON HIM BY THE
PROVISIONS OF SAID CHAPTER 260, AND ANY AMENDMENTS THERETO, AT THE TIMES AND IN THE MANNER
THEREIN PROVIDED, AND SHALL FAITHFULLY COMPLY WITH ALL PROVISIONS OF SAID CHAPTER RELATING TO
HIM AS SUCH LICENSEE, DURING THE PERIOD THAT SAID PRINCIPAL SHALL BE LICENSED AS SUCH
DISTRIBUTOR, THEN THIS OBLIGATION SHALL BE VOID.
RT 133 (Rev. 05/04)

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