Fillable Form Mv-126-Ds-Ls - License Service Surety Bond printable pdf download

Bond No. _______________

MV-126-DS-LS

Rev. 1-2006

SURETY BOND

KNOW ALL MEN BY THESE PRESENTS:

That ________________________________________________________________________ of

(Name of License Service as it appears on Dealer License)

The City of _________________________, County of _______________, West Virginia, as PRINCIPAL

and the ______________________________________________________________________________

(Name of Insurance / Bonding Company)

a corporation, authorized to do business in the State of West Virginia, as SURETY, are held and firmly

bound, effective the _________ day of _______________________, __________, unto the West Virginia

Division of Motor Vehicles (DMV) in the penal sum of Twenty-Five Thousand Dollars ($25,000) for

payment to the West Virginia DMV, we bind ourselves, our successors and assigns, jointly and severally,

firmly by these presents.

THE CONDITION OF THIS BOND IS SUCH THAT, if the Principal practices any fraud or

makes any fraudulent representation which causes a financial loss to a purchaser, seller, financial

institutions or agency, or the State of West Virginia, then the Surety is obligated to pay the penalty sum of

Twenty-Five Thousand Dollars ($25,000) to the West Virginia DMV.

The Surety shall notify the West Virginia DMV by certified mail, within thirty days of

cancellation of the bond by the Surety or the Principal. If the Surety fails to notify the West Virginia

DMV within the thirty days, then the bond will be deemed to be in full force and effect until such

cancellation notice is received by the West Virginia DMV. This bond is required of all License Services

licensed pursuant to Article 6B, Chapter 17A of the West Virginia Code. All pertinent sections of that

statute and all pertinent rules and regulations of the West Virginia DMV are hereby expressly made part

of this bond.

IN WITNESS WHEREOF the said Principal has hereunder set his or its hand, and the said Surety

has caused its corporate name to be signed hereto by its duly authorized official or agent and executed this

instrument the __________ day of ____________________________, ______________.

This bond covers acts and omissions by the Principal that occur during the license year July1,

__________, to June 30, __________, as of the effective date the Principal is issued or renewed license

by the West Virginia DMV.

_________________________________________________

Name of License Service

_________________________________________________

Signature of Individual, Partner, or Corporate Officer

_________________________________________________

Name Surety / Bonding Company

_________________________________________________

Address Surety / Bonding Company

_________________________________________________

Authorized Company Representative

_________________________________________________

Signature of Authorized Company Representative

Form Mv-126-Ds-Ls - License Service Surety Bond