Form Wv/sev-Nrt-Bond 2 - Nonresident Timber Severance Tax Surety Bond (Page 4 of 4) in pdf

ACKNOWLEDGMENT BY PRINCIPAL IF CORPORATION

(19) Enter name of State and County.

(20) Enter name of Notary Public witnessing transactions.

(21) Enter name of Corporate Officer signing bond. (Should by President or Vice-President).

(22) Enter designate Title of Corporate officer signing bond.

(23) Enter name of Company or Corporation

(24) Enter bearing date of bond (also known as execution date). Must be same date entered on line 8 of the bond.

(25) Notary enters date bond was witnessed. May be same as bearing date or any date thereafter.

(26) Affix Notary Seal. If notary is located outside the State of West Virginia, seal must be affixed.

(27) Notary affixes signature here and enters expiration date of appointment.

ACKNOWLEDGMENT BY SURETY

(28) Enter name of State and County.

(29) Enter name of Notary Public witnessing transactions.

(30) Enter name of person having power of attorney to bind Surety Company.

(31) Designate title of person binding Surety Company.

(32) Enter name of Insurance Company (Surety).

(33) Enter bearing date of bond (also known as execution date). Must be same date entered on line 8 of the bond.

(34) Notary enters date bond was witnessed. May be same as bearing date or any date thereafter.

(35) Affix Notary Seal. If Notary is located outside the State of West Virginia, seal must be affixed.

(36) Notary affixes signature here and enters expiration date of appointment

POWER OF ATTORNEY INSTRUCTIONS

Power of Attorney for Surety must be attached and it must show that it was in full force and effect on bearing date (execution)

indicated on the face of the bond, also the raised corporate seal must be affixed to the Power of Attorney.

Name of attorney in fact must be listed (if attorney is a nonresident, bond must be countersigned by West Virginia

resident agent).

Power of Attorney may not exceed imposed limitations.

Certificate date must be the execution date (bearing date) of the bond.

Signature of authorizing official must be affixed. (Signature may be facsimile).

Raised seal must be affixed.

MAILING INSTRUCTIONS

All bond forms must be submitted to and approved by the State Tax Department before commencing any timber harvesting activity

in West Virginia. Bond forms must be mailed to:

West Virginia State Tax Department

Internal Auditing Division

PO Box 1826

Charleston, West Virginia 25327-1826.

Form Wv/sev-Nrt-Bond 2 - Nonresident Timber Severance Tax Surety Bond Page 4