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Form 702 - Motor Fuel, Motor Carrier Or Tobacco Products License Surety Bond Form - Michigan Department Of Treasury

Michigan Department of Treasury, MF

This form is issued under authority of the Motor

702 (Rev. 10-01)

Fuel, Motor Carrier and Tobacco Products Tax

Motor Fuel, Motor Carrier or Tobacco

Acts identified below. The Revenue Commissioner

may require filing of this form and execution of this

Products License Surety Bond

bond as a condition of licensing.

Name of Principal

Account Number

Bond Number

Name of Surety

State of Incorporation

Address of Surety's Main Office (Street or RR#, City, State, ZIP)

We the principal and the surety named above (a corporation organized and existing under the laws of the state identified

above and having its main office at the above-named location, and authorized to do business in the State of Michigan) are

held firmly bound unto the people of the State of Michigan in the full sum of

Enter bond amount in words (not numbers)

United States of America dollars, to be paid to the said people of the State of Michigan. By this bond we firmly bind

ourselves, our successors and/or heirs and assigns, jointly and severally.

Effective Date

Expiration Date

Sealed with our seals and dated this

day of

A.D., 20

The condition of this obligation is such:

That since the above-named principal has applied to the Department of Treasury for the State of Michigan for a license to

engage in business as a (mark only one):

LICENSEE OF MOTOR FUEL (defined in P.A. 403 of 2000).

LIQUID PETROLEUM GAS DEALER (defined in P.A. 403 of 2000).

MOTOR CARRIER (defined in P.A. 119 of 1980, as amended).

WHOLESALER OR UNCLASSIFIED ACQUIRER OF TOBACCO PRODUCTS

(defined in P.A. 187 of 1997, as amended).

And since the Michigan Department of Treasury has required, as a condition precedent to the granting of a license

pursuant to the principal's application, that the principal herein furnish a surety bond running to the people of the State of

Michigan in accordance with the relevant statute;

Therefore, if the above named bounden shall comply with all the laws pertaining to the (strike nonapplicable words)

distribution of motor fuels, sale of tobacco products, or licensing of motor carriers;

shall promptly file true reports, on forms provided by the Michigan Department of Treasury, and pay all taxes and penalties

provided for or required by the law at the time, in the manner and at the place required by the provisions thereof;

and shall furnish such other and further bond as the Michigan Department of Treasury shall deem necessary, on giving ten

days written notice therefore to principal herein; then this obligation shall be void; otherwise to remain in full force and

effect.

Continue and sign on page 2.

Form 702 - Motor Fuel, Motor Carrier Or Tobacco Products License Surety Bond Form - Michigan Department Of Treasury

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