Form Wv/mft-510 A - Motor Fuel Excise Tax Cash Board (Page 2 of 2) in pdf

MOTOR FUEL EXCISE TAX CASH BOND

PREPARATION INSTRUCTIONS

To post a cash bond with the Tax Account Administration Division, Excise Tax Unit, you must complete the

cash bond form and submit with a money order or cashier’s check made payable to the West Virginia State

Tax Department for the amount of the cash bond. In lieu of obtaining a money order or cashier’s check, you

may choose to submit, only in person, the cash bond amount in cash with a properly completed cash bond

form. Please note that certified checks and personal checks are not acceptable.

When completing the cash bond form, all blanks must be completed, and your signature must be notarized.

If the cash bond is submitted after the date the cash bond is required, the effective date of the cash bond must

be retroactive to the date required.

Upon receipt of the cash bond, the cash bond amount will be held in escrow and will not expire until the cash

bond is cancelled. After the cancellation date, the cash bond will remain in effect for a period of sixty-days

from the postmark date of the written registered notice of cancellation. After the cash bond is released, the

cash bond amount will be returned to you. Provided that the commissioner may retain all or part of the cash

bond until such time as the commissioner may perform an audit of the taxpayer’s business or three years,

whichever first occurs.

Lines 1 – 9: Cannot contain white-outs or alterations.

Lines 10 – 18: May contain white-outs or alterations providing notary initials changes.

(1-2)

Enter name and address of Principal (Specify individual, partnership, or corporation) to be covered by cash bond.

(3)

Enter amount of cash bond.

(4)

Enter type of license. (Supplier, Permissive Supplier, Terminal Operator, Importer, Distributor, or Exporter)

(5)

Enter effective date of cash bond.

(6)

Enter execution date of cash bond.

(7)

Enter name of the Principal (individual, partnership, or corporation) covered by cash bond.

(8)

If principal is an individual, affix signature. If principal is a corporation, President or Vice-President must sign cash

bond and underline the appropriate title. If cash bond is to be signed by one other than the President or Vice-

President, affix a copy of corporate resolutions showing authorization of individual to bind corporation.

(9)

If Principal is a corporation, be sure to affix corporate seal, if not available, draw facsimile.

NOTARIZATION INSTRUCTIONS:

(10)

Enter name of State.

(11)

Enter name of County.

(12)

Enter name of Notary Public witnessing transactions.

(13)

Enter name of Principal covered by cash bond if Individual or Partnership.

(14)

Enter bearing date of cash bond (also known as execution date). Must be same date entered on Line 6 of cash bond.

(15)

Notary Public enters date cash bond was witnessed. May be same as bearing date or any date thereafter.

(16)

Affix Notary Seal. If Notary Public is located outside of West Virginia, seal must be affixed.

(17)

Notary Public affix signature.

(18)

Notary Public enters commission expiration date.

Form Wv/mft-510 A - Motor Fuel Excise Tax Cash Board Page 2

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