Form Rv-F1307601 - Tax Bond For Licensee For Sale Of Alcoholic Beverages For Consumption On The Premises Page 2

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SIGNATURE OF PRINCIPAL(S) MUST BE NOTARIZED HERE
State of
County of
On this
day of
, 20
, before me personally
appeared the
, to me known to be
(principal) (principals) described in and who executed the foregoing instrument, and acknowledged that (he) (she)
(they) executed the same as (his) (her) (their) free act and deed.
Notary Public
My Commission expires on the
day of
, 20
.
(SEAL)
SIGNATURE OF ATTORNEY IN FACT* FOR SURETY MUST BE NOTARIZED HEREE
State of
County of
On this
day of
, 20
, before me, a notary public,
personally appeared
, to me known to
be the person who executed the foregoing instrument in behalf of
,
surety, and acknowledged that (he) (she) executed the same as the free act and deed of said surety.
Notary Public
My Commission expires on the
day of
, 20
.
(SEAL)
Approved as to sufficiency and accepted:
Delegate of Commissioner of Revenue
*If this bond is executed by an attorney in fact for any party thereto, a copy of the power of attorney designating
such person as attorney in fact with the authority to execute such instruments must be attached hereto.

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