Form 24b - Nebraska Tax Bond For Nonresident Contractor'S And Subcontractor'S Construction Contracts

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Nebraska Tax Bond for Nonresident Contractor’s
FORM
and Subcontractor’s Construction Contracts
24B
n e
de p
• Read instructions on reverse side
of
• Attach to Form 24A
PLEASE DO NOT WRITE IN THIS SPACE
nebraska
department
of revenue
RESET FORM
2 Federal Employer I.D. or Social Security Number
1 Do you hold or have you previously held a
Nebraska I. D. Number?
NO
YES
3 Surety Bond Number
4 Total Amount of Bond (Minimum $1000 for Each Project Covered)
$
If yes, give number
NAME AND MAILING ADDRESS OF PRINCIPAL
NAME AND MAILING ADDRESS OF PROJECT OWNER
Name
Name
Street or Other Mailing Address
Street or Other Mailing Address
State
State
Zip Code
City
Zip Code
City
7 Location of Project(s)
6 Type of Bond
5
Effective Date of Bond
Month
Day
Year
Single Project
Multiple Registered Projects (Not Less than $5,000)
NAME AND MAILING ADDRESS OF SURETY COMPANY
NAME AND MAILING ADDRESS OF AGENT
Name of Surety Company
Name of Surety Company Agent
Street or Other Mailing Address
Street or Other Mailing Address
City
State
Zip Code City
State
Zip Code
CONDITION OF BOND
For valuable consideration, we, the above-named individual or firm, as principal, and the above-named surety company,
both duly qualified and authorized to transact business in the State of Nebraska, are jointly and severally held, and firmly
bound unto the State of Nebraska, Department of Revenue, in the penal sum shown above, lawful money of the United
States, for the payment of which we hereby bind ourselves, heirs, assigns, successors, executors, and administrators,
firmly by these presents.
If the principal shall pay all taxes including contributions under the Employment Security Law which may accrue to
the State of Nebraska, and all taxes which may accrue to the political subdivisions thereof on account of the execution
and performance of the contract(s) required to be registered under sections 77-3101 through 77-3112 R.R.S. 1943, as
amended, and shall comply with all the provisions thereof, and the regulations issued thereunder, then this obligation
shall be void; otherwise, the same shall be and remain in full force and effect. The obligations of this bond shall begin
on the effective date indicated above.
The bond shall be continuous, and may be deemed canceled at the end of the last day of the calendar month following
receipt of a written notice served by the surety upon the State of Nebraska, Department of Revenue, Lincoln, Nebraska,
provided that at least thirty (30) days notice of such cancellation is received by the State of Nebraska, Department of
Revenue, Lincoln, Nebraska, and provided further that the principal and surety shall not be relieved from any liability
already due or to become due under the laws of Nebraska guaranteed by this bond before the date of cancellation.
sign
here
Signature of Principal
Date
(
)
Telephone Number
Signature of Attorney-in-Fact or Authorized Surety Company Officer
Date
Signature of Agent
Date
Attach this bond to Form 24A and mail to:
NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 98903, LINCOLN, NE 68509-8903
9-2005
7-141-1984 Rev.
Supersedes 7-141-1984 Rev. 3-2003

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