Form Mf-135 - Letter Of Credit
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1
2INDIANA DEPARTMENT OF REVENUE
MF-135
SF# 49169
Letter of Credit
(R2/05-07)
Applicant's Name
Applicant's License Account Number
Prepaid/Gasoline/Special Fuel
Irrevocable Standby Letter Of Credit #
Issuing Bank Name
Address
(
)
Bank FEIN#
Phone Number
Effective Date
Expiration Date
We,
, hereby issue an IRREVOCABLE STANDBY LETTER OF CREDIT for the
Issuing Bank
name of
, in the amount
Applicant's Name and Address
of $
(
Thousand and no/100 Dollars) which is available
by the Indiana Department of Revenue draft drawn at sight of
bearing the clause
Issuing Bank Name
"drawn under
Letter Credit for
"
Issuing Bank Name
Applicant's Name
accompanied by this Letter of Credit and the following:
Statement purportedly signed by an offi cer of the Indiana Department of Revenue certifying that
has been served a pre-warrant notice covering nonpayment of
taxes pursuant to
plus all
Type of Tax
Indiana Code Reference
applicable penalties and interest due the Indiana Department of Revenue and has failed to provide an acceptable explanation within the
time period for such protests or payment of tax.
A copy of the pre-warrant notice which bears the expiration date of at least fi ve (5) days prior to the date of the draft.
Drawings may be made up to an aggregate amount but not to exceed
.
Amount of Letter of Credit
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Parent category: Financial