Form Dr-157 - Fuel Tax Surety Bond
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1MAIL TO:
DR-157
Fuel Tax Surety Bond
ACCOUNT MANAGEMENT - FUEL UNIT
R. 11/10
FLORIDA DEPARTMENT OF REVENUE
PO BOX 6480
TALLAHASSEE, FL 32314 - 6480
Please complete and submit an original bond form for each fuel product type or taxable pollutant. An applicant cannot
be issued a fuel license by the Department of Revenue until the proper security is submitted. An importer’s bond is
required in addition to a wholesaler’s bond pursuant to Rule 12B-5.030, F.A.C. If further information is needed, please
contact Account Management at 800-352-3671.
State of ______________ County of _____________________________bond number __________________________________
We, ____________________________________________, as principal , and __________________________________________ ,
(name of principal)
(name of surety)
as surety, are bound to the Florida Department of Revenue on behalf of the State of Florida, in the sum of
$ _____________________________ for the payment of which we bind ourselves, our successors and assigns, heirs, and
personal representatives, jointly and severally.
Principal acknowledges that _________________ is engaged in business which is subject to the Florida Statute
(he, she, it)
identified below: (Please check the appropriate box.)
(
) Motor fuel pursuant to Chapter 206, F.S.
(
) Pollutants tax pursuant to Chapter 206, F.S.
(
) Diesel fuel pursuant to Chapter 206, F.S.
(
) Importer’s bond pursuant to section 206.051, F.S.
(
) Aviation fuel pursuant to Chapter 206, F.S. (
) Alternative fuel pursuant to Chapter 206, F.S.
THE CONDITION OF THIS BOND is that if the principal faithfully complies with the Florida statutory tax provisions
regarding such business of the principal then this bond is void; otherwise it remains in force.
The surety agrees that if the surety wishes to cancel this bond, notification must be submitted in writing to the
Department of Revenue. The bond will be cancelled sixty (60) days after the Department receives notification. The
surety is liable for acts committed by the principal and covered by the terms of the bond until it is cancelled.
This bond shall be effective as of the _________ day of _____________________________, ______
(month)
(year)
Signed this________day of __________________ , _______.
(month)
(year)
As Principal
For DOR Use Only
By ____________________________________________
(Principal’s name)
As Surety
Accepted this ______ day of ________________, ______ .
By ____________________________________________
(month)
(year)
(Surety’s name)
Florida Department of Revenue
_____________________________________________
(Surety’s FEIN)
By _______________________________________________
_____________________________________________
Name
(Surety’s address)
_____________________________________________
__________________________________________________
(City, State, ZIP)
Title
By ____________________________________________
As Attorney-In-Fact and Florida Resident Agent for Surety
Account Number: __________________________________
(Authority of Attorney-In-Fact and Florida
Resident Agent must be attached)
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