Form B-A-34 - Tax Liability Bond Increase Or Decrease Rider Cigarette Tax

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B-A-34
Tax Liability Bond Increase or Decrease Rider
G.S. 105-113.13(b)
Cigarette Tax
Web
3-07
North Carolina Department of Revenue
NORTH CAROLINA
WAKE COUNTY
To be attached to and form part of Bond No._____________________dated ______________ ,
(Date of Original Bond)
the SURETY being ______________________________________________________________ ,
(SURETY Company)
being made on behalf of _______________________________________________________ ,
(PRINCIPAL Name)
the PRINCIPAL therein, in favor of the STATE OF NORTH CAROLINA.
It is understood and agreed that the sum of the attached bond is hereby
increased /
decreased from
______________________________________________
dollars ($
_______________
), to
(Current Amount of Bond)
_______________________________________________
dollars ($
) ,
(Revised Amount of Bond)
said increase/decrease being applicable only as to acts or omissions on or after the ___________day
of
___________________
______, ______. Note: If this is a decrease rider, the applicability
(Month)
(Year)
date must be more than 30 days after receipt by the Secretary of Revenue of notice of the
proposed decrease.
Nothing herein contained shall serve to waive, alter, modify or terminate any of the terms and
conditions of the subject bond other than as herein expressly set forth.
,
.
Signed, sealed and delivered this
day of
(Month)
(Year)
INDIVIDUAL PRINCIPAL:
(SEAL)
(Signature)
(Print Name)
AFFIX SEAL OF
PARTNERSHIP PRINCIPAL:
(Print Name of Partnership)
CORPORATION/LLC
BY:
(SEAL)
(Signature)
(Title)
(Print Name of Signer)
ATTEST:
CORPORATION/LLC PRINCIPAL:
(Print Name of Corporation/LLC)
BY:
(Signature)
(Title)
(Signature)
(Title)
(Print Name of Signer)
(Print Name)
SURETY:
(Print Name of Surety Company)
AFFIX SEAL OF
BY:
SURETY
as Attorney in Fact for
(Signature)
SURETY HERE
(Print Name)
COUNTERSIGNED:
(N.C. REGISTERED AGENT OF SURETY)
North Carolina Department of Revenue, Attention: Tobacco Products Tax Unit,
P.O. Box 871, Raleigh, NC 27602

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