Form Sfn 21872 - Sales And Use Tax Permit Cash Bond

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SALES AND USE TAX PERMIT CASH BOND
OFFICE OF STATE TAX COMMISSIONER
SFN 21872 (Rev. 8-2002)
Attached hereto is $ ________________ in the form of a __________________________
(certified check, cashier's check or money order)
which represents a cash bond deposit posted by me to secure the payment of any sales or use tax,
penalties, or interest imposed by North Dakota Century Code chs. 57-39.2 and 57-40.2, which
may become due from me or from the firm listed below.
Dated this _____________ day of ________________________, 20 ______.
Firm Name ____________________________________________
Owner ________________________________________________
Address _______________________________________________
City, State, Zip Code ____________________________________
MAIL TO:
Office of State Tax Commissioner
Sales And Use Tax Division
600 E. Boulevard Ave., Dept. 127
Bismarck, North Dakota 58505-0599

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