Form Au-766 - Guarantee Bond - 2003 printable pdf download

Department of Revenue Services

Form AU-766

State of Connecticut

Guarantee Bond

Attn: Discovery Unit

25 Sigourney Street

Hartford CT 06106-5032

(New 09/03)

Purpose: A nonresident contractor working in Connecticut and a surety company licensed to do business in Connecticut use Form AU-766 to post a

guarantee bond with the Department of Revenue Services (DRS) for a specific project in the state. The guarantee bond ensures that all taxes due to the

State of Connecticut from the contractor are paid to DRS. Read the instructions on the reverse side before you complete this form. If you need help, call

860-541-3280, Monday through Friday, 8:00 a.m. to 5:00 p.m., and choose Option 7.

Part I: Nonresident Contractor Information

Name

Connecticut Tax Registration No.

Address (Street or PO Box, City, State, and ZIP Code)

Part II: Person Doing Business With a Nonresident Contractor Information

Name

Connecticut Tax Registration No., Federal ID No., or SSN

Address (Street or PO Box, City, State, and ZIP Code)

Part III: Surety Company Information

Name

Bond No.

Amount of Bond

Address (Street or PO Box, City, State, and ZIP Code)

Part IV: Project Information

Check the box if this bond is for a change order

Physical Location of Project (Street, City or Town)

Name of Project

Commencement Date

Completion Date for

Total Contract Price or Amount of Change Order

Amount of Deposit

Nonresident Contractor

Conditions of the obligation for the project detailed above:

•

The nonresident contractor has entered into a contract related to real property at a Connecticut location.

•

The nonresident contractor and the surety company are posting a bond of 5% of the total contract price, including any change orders and add-ons,

with DRS to ensure that all taxes that become due and owing during the period of the contract will be paid.

•

A bond must be posted within 120 days of the commencement of the contract for contracts lasting 120 days or more. If the deadline for the person

doing business with a nonresident contractor to withhold and remit a deposit to DRS is before the deadline for the nonresident contractor to post

a bond, DRS will accept the earlier of the deposit or the bond.

•

If the nonresident contractor pays all taxes, interest, and penalties within three years, one month, and one day after completion of the contract, the

bond expires; otherwise the obligation remains in full force.

•

This bond jointly and severally binds the nonresident contractor and the surety company, their heirs, executors, administrators, successors, and

assigns for payment of this obligation.

Declaration: I, the nonresident contractor named above or its authorized agent, declare under the penalty of law that I have examined Form AU-766

and, to the best of my knowledge and belief it is true, complete, and correct. I understand that the penalty for willfully delivering a false document or

return to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.

Print Name

Title

Authorized Signature

Date

Declaration: I, an authorized agent of the surety company named above, declare under the penalty of law that I have examined this Form

AU-766 and, to the best of my knowledge and belief it is true, complete, and correct. I understand that the penalty for willfully delivering a false

document or return to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.

Seal:

Print Name

Title

Authorized Signature