Form Gas-1262 - Motor Fuels Application - North Carolina Department Of Revenue - 2008 Page 21
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23Page 2
Gas-1212
Web-Fill
5-09
It is further understood and agreed that the Secretary of Revenue may cancel said license, registration cards and
vehicle identifications by giving ten days notice in writing to the principal and surety herein, and may at the discretion of the
Secretary of Revenue, during the life of this bond, by giving twenty days notice in writing, demand of the principal named herein
other or additional security, and upon the principal’s failure to comply with such demand within ten days after such notice, the
Secretary of Revenue may revoke the license, registration cards and vehicle identifications issued to such Supplier, Distributor
or User.
(SEAL)
Attest:
Principal
____________________________________
By:
(Title)
(Title)
(SEAL)
Surety
By:
Attorney-in-Fact
INSTRUCTIONS FOR EXECUTING BOND
I.
CORPORATION
1.
The legal corporate name followed by any trade name, if applicable, must be placed in all instances wherein the
principal is named.
2.
The corporate seal must be affixed beside and after the corporate name over the word “SEAL”.
3.
Beside the word “By”, the signature of the President or Vice-President must appear and the word “President” or “Vice-
President” written beneath the signature.
4.
Under Attest, the Corporate Secretary must sign and indicate the title “Secretary” beneath the signature. In the
absence of a Secretary, a letter is required from another officer not appearing on the bond verifying that the appropriate
person has signed the bond to bind the company.
II.
PARTNERSHIP
1.
On the face of the bond where the principal is named, the names of all partners must appear immediately preceding
the trade name of the partnership.
2.
The name of the partnership must be placed on the line immediately over the word “Principal”.
3.
Beside the word “By”, one or more of the partners should sign and designate “Partner” beneath the signature. If a
limited partnership, list the name of the general partner followed by “General Partner” beneath the signature. If
corporate partners, see items 3 and 4 under I. Corporation shown above.
III.
INDIVIDUAL
1.
If the principal is an individual using a trade name, the individual should place his/her name above the word
“Principal”.
2.
Immediately beneath the signature, add, T/A, followed by the trade name.
3.
On the face of the bond, the name of the individual followed by the trade name must appear where the principal is
named.
IV.
LIMITED LIABILITY COMPANY (“LLC”)
1.
If the principal is an LLC, the name of the LLC should appear where the principal is named.
2.
Beside the word “By”, the signature of the manager of the LLC must appear and the word “Manager” written below the
signature.
3.
Under Attest, the Secretary of the LLC must sign and indicate the title “Secretary” beneath the
signature. In the
absence of a Secretary, a letter is required from another officer not appearing on the bond verifying that the appropriate
person has signed the bond to bind the company.
4. If the LLC has a corporate seal, place the seal over the word “SEAL” beside the name of the principal.
THIS BOND MUST BE ACCOMPANIED BY A VERIFIED COPY OF THE AUTHORITY OF THE PERSON EXECUTING THE SAME TO DO SO ON
BEHALF OF THE CORPORATE SURETY.
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