Form Cg-106 - Wholesale Cigarette Dealer'S Bond Form - Kansas Department Of Revenue

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KANSAS DEPARTMENT OF REVENUE

MISCELLANEOUS TAX – CUSTOMER RELATIONS

915 SW HARRISON ST.

TOPEKA, KANSAS 66612-1588

Website:

Email: miscellaneous.tax@kdor.ks.gov

Bond No. _______________

Phone: (785) 368-8222

Fax: (785) 296-4993

(Affix Bond No. on Document)

WHOLESALE CIGARETTE DEALER’S BOND

KNOW ALL MEN BY THESE PRESENTS: THAT________________________________________________________________ with main

(Principal)

office location at ________________________________________________________________________________________ as Principal, and

(Street Address)

(City)

(State & Zip Code)

the __________________________________________________________________________________________ a corporation authorized to

(Surety Company Name)

transact business in Kansas, as surety, are held and firmly bound unto the STATE OF KANSAS in the sum of ______________________________

dollars ($___________________), lawful money of the United States, to the payment of which, well and truly to be made, we hereby bind ourselves,

our heirs, as individually set out below in the following schedule:

S Wholesale Cigarette Dealer’s License

$ ____________________

S Wholesale Cigarette Dealer’s Tax Credit

$ ____________________

WHEREAS, The above-named principal, a LICENSED WHOLESALE CIGARETTE DEALER within the provisions of Chapter 79, Article 33,

G.S., Kansas, 1949, and amendments thereto, is authorized to affix cigarette tax stamps or Kansas tax indicia to packages of cigarettes at his/their

licensed location at:

_________________________________________________ ________________________ ________________________________

(Street Address)

(City)

(State & Zip Code)

and is required by such law to comply with all the provisions of said law together with the Sales and Compensating Tax Rules and Regulations

pursuant thereto, as adopted by the Director of Taxation; and to make such reports and furnish such information as the Director of Taxation may

require, to said Director at his office in Topeka, Kansas; and to further pay all taxes due and owing the State of Kansas as provided in said Kansas

Cigarette Tax Law. The forfeiture of any Wholesale Dealer’s Bond shall be in an amount only to the extent of moneys due and owing the State of

Kansas.

NOW, THEREFORE, The condition of this obligation is such that if the above-named principal shall faithfully comply with all the provisions of

Chapter 79, Article 33, G.S., Kansas, 1949, and amendments thereto, together with the Sales and Compensating Tax Rules and Regulations

promulgated by the Director of Taxation pursuant thereto, then this obligation shall be void and of no effect; otherwise it shall be and remain in full

force and effect. Said principal hereby authorizes employees of the Department of Revenue to disclose to the surety herein a statement of account

relating to the tax guaranteed by this bond.

This bond is effective on and after the _______________ day of ______________________________________, ____________.

(Year)

Witness our hands at ______________________________, Kansas, this _________________ day of ____________________________, ___________

(Year)

_________________________________________________

(Principal)

By ___________________________________________________

(Indicate Position: President, Vice-President, Partner, Owner)

Attest _____________________________________________

_________________________________________________