Form Wv/cab-1 - Collection Agency Bond - 2011 printable pdf download

BOND NUMBER: __________________________

WV/CAB-1

Rev. 5/11

WEST VIRGINIA STATE TAX DEPARTMENT

Revenue Division

COLLECTION AGENCY BOND

KNOW ALL MEN BY THESE PRESENTS:

(1)

That we, (Principal): __________________________________________________________________________________________

(2)

Address: ___________________________________________________________________________________________________

(3)

As Principal, and (Surety Company): _____________________________________________________________________________

(4)

Address: ___________________________________________________________________________________________________

a firm and/or a corporation authorized to do business in the State of West Virginia, as Surety, are held and firmly bound unto the State

(5)

of West Virginia in the just and full sum of five thousand dollars ($5,000.00) to the payment whereof well and truly to make, we bind

ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents.

WHEREAS, the above bound Principal is a collection agency

within the meaning of Chapter 47, Article 16, of the Official Code

of West Virginia of 1931, as amended, and whereas the Tax Commissioner of the State of West Virginia has required the said

Principal to deposit a Bond, in accordance with the provisions of Chapter 47, Article 16, Section 4 of the said Code of West

Virginia.;

NOW THEREFORE, if said Principal shall in all respects fully comply with the provisions of Chapter 47, Article 16, of the

Code of West Virginia, and the rules and regulations adopted and promulgated thereunder, and shall account for and pay damages for

which said Principal shall be liable, and shall protect and save harmless the State of West Virginia

or a private person from any loss

arising from the failure of the Principal to pay such damages, for any cause whatsoever, then this obligation shall be void; otherwise to

remain in full force and effect

unless any of the signatories hereto give written notice by registered mail to the other signatories hereto

that the signatory desiring the cancellation intends to cancel this bond sixty (60) days after the post-mark date of the written registered

notice. Notices of renewal are not required.

The Principal hereby waives the confidential provisions of West Virginia Code §11-10-5(d) and authorizes the Tax Department

to release to the surety company information necessary to file proof of claim, concerning any tax liability covered by this bond and

accruing during the effective dates of this bond.

(6)

This bond shall be effective from the __________ day of _______________, 20__________.

IN WITNESS WHEREOF the said principal has hereunder set his/her or its hand and affixed his/her or its seal, and the said

surety has caused its corporate name to be signed hereto and its corporate seal to be hereunto affixed by its duly authorized officer or

agent and

(7)

executed this instrument this __________ day of _______________, 20 _________.

(8) ___________________________________________________________

(Principal)

(9) By: _______________________________________________________

Title: Must be President or Vice-President or authorized individual

Affix: Principal Corporate Seal

(10)

(A drawn facsimile is acceptable if no corporate seal)

________________________________________________________

(LLCs are not required to provide a seal)

(11)

(Print Name of Person Signing)

(12) ___________________________________________________________

(Surety Company)

(13) By: _______________________________________________________

(Title)

Affix: Surety Corporate Seal

(14)

Form Wv/cab-1 - Collection Agency Bond - 2011

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