Form 04-041w - Cigarette And Tobacco Products Wholesaler-Distributor Tax Bond
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1Alaska Department of Revenue
PO Box 110420
Juneau, Alaska 99811-0420
Cigarette and Tobacco Products
WHOLESALER-DISTRIBUTOR TAX BOND
AS 43.50.035
KNOW ALL MEN BY THESE PRESENTS:
BOND NO.
That we,
(Principal)
o f
(Type of Business Entity)
(Address)
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 to execute this bond, are held and firmly bound unto
the State of Alaska, in the sum of $ ___________________, the payment of which we bind ourselves, our
executors, administrators, heirs, assigns, and successors, jointly and severally, firmly by these presents.
The conditions of the above bond are such, that whereas, the above named principal is a Wholesaler-
Distributor of tobacco products in the State of Alaska under the purview of AS 43.50.320, and is under a duty
to report sales and remit excise taxes to the State of Alaska as prescribed by said Act.
Now, if the said principal shall well and truly fulfill said obligations, by making true and timely returns and
remittances in full to the Commissioner of Revenue at Juneau, Alaska, in accordance with all of the requirements
of AS 43.50.010-390, then this bond is to be null and void; otherwise to remain in full force and effect.
IN WITNESS WHEREOF, the above bound parties have executed this instrument this __________ day of
_______________, the name of each party being hereto affixed and these presents duly signed by its
undersigned representative, if any, pursuant to authority of its governing body.
(seal)
(Principal)
ATTEST:
By:
(Authorized Agent)
(Secretary of Principal)
(seal)
(Surety)
ATTEST:
By:
(Secretary of Surety)
(Authorized Agent)
Form 04-041W (New 4/97)
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