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(L.S.)

ATT-108 (REV. 1/97)

WINE BOND

WINERY - MANUFACTURER- IMPORTER - BROKER

PERFORMANCE AND TAX LIABILITY BOND

GEORGIA DEPARTMENT OF REVENUE

CALENDAR YEAR

ALCOHOL & TOBACCO DIVISION

P.O. BOX 38368

ATLANTA, GA 30334

BOND NO.

STATE OF GEORGIA

KNOW ALL MEN BY THESE PRESENTS,

That we,

(NAME OF LICENSEE AS SHOWN ON APPLICATION)

and

, as Principal

(NAME OF CORPORATION OR PARTNER(S) AND D/B/A)

and

(NAME OF SURETY COMPANY EXECUTING BOND)

a surety company incorporated and existing under the laws of the State of

, and licensed and authorized to execute

bonds and undertakings as a surety in the State of Georgia, AS SURETY, are held and firmly bound unto the State Revenue Commissioner of the State of

Georgia , and his successor in office, for the use and benefit of said State, AS OBLIGEE, in the sum of FIVE THOUSAND AND NO/100 ($5000.00) DOLLARS,

for the payment of which, we bind ourselves, our heirs, executors, administrators, and successors, as the case may be, jointly, severally and firmly by these

presents.

Signed with our hands and sealed with our seals, this

day of

, 19

WHEREAS, the above-named Principal has applied to the State Revenue Commissioner of the State of Georgia for a license to engage in business as a

Winery - Manufacturer - Importer - Broker of Wine, under the provision of the Georgia Alcoholic Beverage Code (Section 3-6-21 O.C.G.A. and as hereafter

and

amended), and the regulations promulgated pursuant thereto, for a period beginning

day of

ending December 31, 19___, inclusive.

NOW, THEREFORE, the conditions of this bond are such that if the Principal shall promptly pay to the Obligee all sums which may be due by said Principal as

taxes, license fees, rental charges, or otherwise, including penalties and interest, by reason of the operation of said business, together with expenses incurred by

the State in the collection of amounts due the State, the nature and amount of such expenses to be determined by the Commissioner; and shall, in the

operation of said business, faithfully comply with all provisions of said Act, as amended, and with all rules and regulations now, or hereafter, promulgated by the

State Revenue Commissioner under the authority of said Act, as amended, for the enforcement and administration of said Act, and with such other conditions

as the State Revenue Commissioner may require in rules and regulations, then this bond shall be void; otherwise, it shall remain of full force and effect and

shall be construed as a bond of forfeiture.

This bond may be canceled by the Principal, the Surety or the Obligee by giving sixty (60) days’ notice in writing to each of the other parties hereto at their last

known address, but no such cancellation shall affect the liability of either the Principal or the Surety occurring before the expiration date of such notice.

This bond shall be in force for the period beginning on the

day of

, through the 31st day of

, 19

December, 19

, inclusive, and shall not be construed as a renewal or continuation of any other bond executed by said Principal and Surety to

Obligee for any other period.

IN WITNESS WHEREOF, the said Principal has hereunto set his hand and affixed his seal, and the said Surety has caused these presents to be duly executed

by its duly authorized officials, or its duly authorized attorney in fact, and its corporate seal to be hereunto affixed, the day and year first above written.

COUNTERSIGNED:

PRINCIPAL

(Agent of Surety located within Georgia)

(Signature of Licensee)

(Address)

SURETY

(State)

(Zip Code)

(Attorney in Fact)

NOTE: The official or attorney in fact signing for Surety shall attach to the original bond a certified copy of the authority or power to bind the surety. It shall show

that the power is in force and effect at the time of the execution of the bond.