Form Cigbond - Cigarette Wholesaler'S Bond printable pdf download

*0-0-1704-099*

Wyoming Department of Revenue

Excise Tax Division

122 W. 25th Street, Herschler Bldg.

Cheyenne, Wyoming 82002-0110

CIGARETTE WHOLESALER’S BOND

We, _________________________________________________________________________________________

Street address or Box No. ________________________________________________________________________

City ___________________________ State ___________________ Zip _____________as PRINCIPAL and

____________________________________________________________________________a corporation

organized under the laws of the State of ______________________________ and authorized to do a surety business in the State

of Wyoming, as SURETY, are held and firmly bound, jointly and severally unto the State of Wyoming in the penal sum of

______________________________________________ dollars ($_______________________________________) lawful

money of the United States, to be paid the Wyoming Department of Revenue, as agent of the State of Wyoming for which

payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, or assigns, and each of

them, jointly and severally.

The above Principal has been licensed as a cigarette wholesaler as provided by Wyoming Statute 39-18-102(a). As a cigarette

wholesaler, the Principal is authorized and required to affix stamps, imprints or impressions on each package of cigarette sold or

distributed in the State of Wyoming.

The condition of this obligation is such that if all payments in other than cash, made by the Principal to the Department of

Revenue for the purchase of cigarette stamps are honored when presented for payment, the obligation is void, otherwise to

remain in full force and effect.

The Surety may terminate its liability after giving written notice to the Department of Revenue. The termination shall become

effective thirty (30) days after actual receipt of said notice of termination by the Department of Revenue, however, the Surety’s

liability remains in effect for those payments made by the Principal and received by the Department prior to the effective date

of the termination.

This obligation shall become effective on the _______ day of ___________________, 20___, and shall continue in force until

termination in the manner above provided.

In witness whereof, we have hereunder set our respective hand and seal this ___________ day of ______________, 20_____.

_______________________________________________

_________________________________________________

Name of Principal(s)

Corporate Surety

By: ____________________________________________

By: ______________________________________________

(Signature - President or Vice President) Title

_______________________________________________

Its ______________________________________________

Secretary of Corporation

Principal’s Corporate Seal:

Surety’s Corporate Seal

(If none, so state)

_______________________________________________

________________________________________________

For Department Use Only

Wyoming Resident Agent

________________________________________________

Agency

________________________________________________

Address

________________________________________________

City,

County

See Reverse Side for Information and Instructions

ETS Form CIGBOND Revised: 5/9/11

Form Cigbond - Cigarette Wholesaler'S Bond

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