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REGISTERED PRODUCERS LICENSE TAX LIABILITY BOND FORM

GEORGIA DEPARTMENT OF REVENUE

1800 CENTURY BLVD.

ATLANTA, GA 30345

STATE OF GEORGIA

FILE/BOND NUMBER___________________________

COUNTY OF _____________________________________________________

STI#_____________________________________

(if applicable)

CALENDAR/LICENSE YEAR ______________________

KNOW ALL PERSONS BY THESE PRESENTS , That we _____________________________________________________________

NAME OF ENTITY AS SHOWN ON APPLICATION

and ________________________________________________________________________________________, AS PRINCIPAL

NAME OF CORPORATION OR PARTNER(S) AND/OR (DBA)

and ________________________________________________________________________________________________________

NAME OF SURETY COMPANY EXECUTING BOND

A surety company incorporated and existing under the laws of the State of __________________________, and licensed and authorized

to execute bonds and undertakings as a surety in the State of Georgia, AS SURETY, are held and firmly bound unto the State, AS

OBLIGEE, in the sum of $ _____________________________________________ DOLLARS, for the payment of which, we bind

ourselves, our heirs, executors, administrators and successors, as the case may be, jointly, severally and firmly by these presents.

WHEREAS, the above-named Principal has applied to the State Revenue Commissioner of the State of Georgia for a license to engage

in business at

_____________________________________________________________________________________________________________

as a registered producer or joint registrant of distilled spirits under the provision of the Georgia Alcoholic Beverage Code, (Section 3-4-22

O.C.G.A. and as hereafter amended), for a period beginning the 1st day of January 20____, and ending December 31, 20____, inclusive.

NOW, THEREFORE, the condition of this bond is such that if the Principal shall promptly pay to the Obligee all sums which may be due

by said Principal as taxes, license fees, rental charges, or otherwise, including penalties and interest, by reason of the operation of said

business, together with expenses incurred by the State in the collection of amounts due the State, the nature and amount of such

expenses to be determined by the Commissioner; and shall, in the operation of said business, faithfully comply with the laws of Georgia,

as amended, and with all rules and regulations now, or hereafter, promulgated by the State Revenue Commissioner, as amended, for the

enforcement and administration of the laws of Georgia, and with such other conditions as the State Revenue Commissioner may require

in rules and regulations, then this bond shall be void; otherwise, it shall remain of full force and effect and shall be construed as a bond of

forfeiture.

This bond may be cancelled by the Principal, the Surety or the Obligee by giving sixty (60) days' notice in writing to each of the other

parties hereto at their last known address, but no such cancellation shall affect the liability of either the Principal or the Surety occurring

before the expiration date of such notice.

IN WITNESS WHEREOF, the said Principal has hereunto signed and sealed, and the said Surety has caused these presents to be

duly executed by its duly authorized officials, or its duly authorized attorney in fact, and its corporate seal to be hereunto affixed, the day

and year first above written.

Signed and sealed this _______ day of ___________________, 20_______.

PRINCIPAL

SURETY

____________________________________________________

(Signature of Licensee / Authorized Corporate Officer)

(Attorney in Fact)

NOTE: The official or attorney in fact signing for Surety shall attach to the original bond a certificate copy of authority or power to bind the

Surety. It shall show that the power is in force and effect at the time of the execution of the bond.

Registered Producers License Tax Liability Bond Form - Georgia Department Of Revenue

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