Form 04-062 - Fisheries Business Bond - Alaska Department Of Revenue

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Alaska Department of Revenue
PO Box 110420
Juneau, AK 99811-0420
Fisheries Business Bond
AS 43.75.055
Principal Name _ _______________________________________
Bond Number
Principal Address ______________________________________
_____________________________________
Business Type (check one):
! Corporation
! Partnership
! Sole proprietor
! LLC
! 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 $
, for
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 fisheries
assessments, 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 fish tax,
assessments and licensing laws of the State of Alaska.
The liability hereby assumed is to continue so long as the above bound principal shall be engaged in the
fisheries business in the State of Alaska and for a period thereafter until the statute of limitations has expired on
all fisheries business taxes due to the State of Alaska of said fisheries business at
(Location of Operation)
In witness whereof, the above bound parties have executed this instrument this
day of
, 20
the name and seal 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:
(Principal)
By:
(Secretary of Principal)
(Authorized Agent)
(seal)
ATTEST:
(Surety)
By:
(Secretary of Surety)
(Authorized Agent)
Form 04-062 (Rev 11/01)
Page 11

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