Bond Number ____________________
MOTOR FUELS TAX
Commonwealth of Kentucky
WATERCRAFT REFUND BOND
DEPARTMENT OF REVENUE
Effective Date ____________________
KNOW ALL MEN BY THESE PRESENTS, that we, ________________________________________________________ ,
Name of principal
Street or P. O. Box
State and ZIP Code
as principal, and _________________________________________________ of _______________________________________ ,
Name of Surety
Address of Surety
as surety, are held and firmly bound unto the Commonwealth of Kentucky in the sum of $1,000, for the prompt and faithful compliance
with the provisions of Kentucky Revised Statute 138.445, we bind ourselves, our heirs, executors, administrators, successors and
assigns, jointly and severally, firmly by these presents.
The condition of this obligation is such that, whereas, the Principal is now engaged in, or is about to engage in, the sale of
liquid fuel for the operation of watercraft, and in such operation is entitled to a refund of the tax paid on liquid fuel purchased by a
public boat dock operator or other dispensing facility which floats upon the water to be sold for use in the operation of watercraft, and
whereas, the Principal from time to time will be making applications to the Commonwealth of Kentucky for refund of taxes paid on
liquid fuel used in watercraft.
NOW THEREFORE, the condition of this obligation is such that, if the Principal shall faithfully comply with the provisions of
the aforementioned Kentucky Revised Statue 138.445 and repay to the Commonwealth of Kentucky any refunds to which it is not
entitled, then this obligation shall be void, otherwise it shall remain in full force and effect. Provided, however, this bond can be
terminated by the surety upon written notice to the department and Principal given by registered mail 60 days in advance.
IN WITNESS WHEREOF, we have hereunto set our hands this ___________________ day of ____________ , 20 ______ .
Owner or President
and/or Kentucky Resident Agent of Surety Company
Address of Kentucky Resident Agent
Return to Department of Revenue, Motor Fuels Tax Compliance Section, Frankfort, Kentucky 40620.
DO NOT COMPLETE—FOR DEPARTMENT USE ONLY