Form Gas-1262 - Motor Fuels Application - North Carolina Department Of Revenue - 2008 Page 20
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Gas-1212
Web-Fill
Motor Fuels Tax
5-09
PRINT
CLEAR
Liability Bond
North Carolina Department of Revenue
WAKE COUNTY
KNOW ALL MEN BY THESE PRESENTS That we ______________________________________________________
_______________________________________________________________________________________________________
as principal, and _________________________________________________________________________________________
as surety being a bonding company authorized to do business in the State of North Carolina, are held and firmly bound unto
the State of North Carolina in the sum of $ ___________________________________________________________________
Dollars ($____________________), to the payment of which, well and truly to be made, we bind ourselves, our heirs, administrators
and successors firmly by these presents, this obligation to be effective as to acts or omissions occurring on or after the
______________________ day of _________________________, 20______.
IN TESTIMONY WHEREOF, The principal has hereunto set his hand and seal, and the Corporate Surety caused its
corporate name to be hereunto signed and its corporate seal attached, duly witnessed by its proper officer.
This _____________ day of ____________________________, 20______.
THE CONDITIONS OF THIS BOND ARE SUCH, That Whereas the principal herein has applied to the Secretary of
Revenue of the State of North Carolina, for a said license, registration cards and vehicle identifications as Supplier, Distributor or
User of Motor Fuels in the State of North Carolina.
NOW, THEREFORE if the said principal shall render such reports, shall pay all taxes, and otherwise comply with the
law and the rules and regulations promulgated by the Secretary of Revenue relating to the Sale, Use and Distribution of Motor
Fuels in the State of North Carolina under and by virtue of the authority of Subchapter V of Chapter 105 of the General Statutes,
including but not limited to Articles 36B, 36C, and 36D, and the authority of Chapter 119, including but not limited to Article 3, as
the same may be from time to time amended, modified, recodified, or otherwise rewritten, then this obligation to be null and void;
otherwise to be and remain in full force and effect.
It is understood by and between the parties hereto that this bond may be canceled at the instance of either principal or
surety after thirty days notice in writing given by registered mail to the other party and to the Secretary of Revenue, such
cancellation, however, to be prospective in effect only, and shall not affect any liability incurred prior to such cancellation.
It is expressly provided that such notice to the Secretary of Revenue shall be a condition precedent to the cancellation
of this bond, and, if such condition is not satisfied, any cancellation or attempted cancellation, insofar as the same relates to
the rights of the State of North Carolina shall be null and void and of no effect.
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