Form 04-409 - Motor Fuel Excise Tax Qualified Dealer Bond - 1998
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1Alaska Department of Revenue
PO Box 110420
Juneau, AK 99811-0420
Motor Fuel Excise Tax
QUALIFIED DEALER BOND
AS 43.40.100
Principal Name _ _______________________________________
Bond Number
Principal Address ______________________________________
______________________________________
Business Type (check one):
q Corporation
q Partnership
q Sole proprietor
q LLC
q Other
We, as principal(s), and
as surety,
(Name of Insurance Company)
a corporation incorporated under the laws of the State of
and authorized to do business in the State of Alaska and execute this bond, are held and firmly bound
unto the State of Alaska, Department of Revenue, in the sum of $
, the
payment of which we bind ourselves, our executors, administrators, heirs, assigns, and successors,
jointly and severally, firmly by this bond.
The condition of the foregoing obligation is that the above bound principal(s) shall pay when due all
motor fuel excise fees and/or taxes, penalties and interest due and to become due and owing to the State
of Alaska by said principal during the effective period of the bond, under the provisions of the motor
fuel excise tax and licensing laws of the State of Alaska (AS 43.40).
Liability under this bond begins
and shall be continuous thereafter until the
(Date)
statute of limitations has expired on all motor fuel excise taxes due to the State of Alaska. The bond
shall apply to all liens and liabilities which arise during the effective period of the bond and to which the
bond is applicable under law, even if the liens are foreclosed or valid liens settled after the period of the
bond or the liabilities are enforced after the effective period of the bond.
In witness whereof, the above bound parties have executed this instrument this
day of
, 19
the name of each party being hereto affixed and is duly signed by its
undersigned representative, if any, pursuant to authority of its governing body.
(seal)
ATTEST:
By:
(Secretary of Principal)
(Authorized Agent)
(seal)
ATTEST:
By:
(Secretary of Surety)
(Authorized Agent)
Form 04-409 (Revision 5/98)
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