Form Rv-F1307101 - Bond Of Warehousemen, Dealers, Wholesalers, And/or Manufacturers Of Beer Or Any Other Such Beverage Used As A Measure Of The Tax Levied Under Chapter 5 Of Title 57 Inclusive, Tennessee Code Annotated Page 2

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The premium for which this bond is written is
Dollars ($
). In witness whereof, the parties have executed
, the
this bond at
day of
, 2
.
Surety
Corporate Principal
By
President, Secretary or Attorney in Fact*
Attorney in Fact*
State of Tennessee
County of
Before me, a notary public of the state and county aforesaid, personally appeared
with whom I am personally acquainted, and who, upon oath, acknowledged (himself) (herself) to be the (president) (secretary)
(attorney in fact*) of
,
the within named principal, a corporation, and (he) (she), as such (president) (secretary) (attorney in fact*), being authorized
so to do, executed the foregoing instrument as the free act and deed of said principal for the purpose therein contained, by
signing the name of the corporation thereto by (himself) (herself) as (president) (secretary) (attorney in fact*).
Witness my hand and seal at office
County,
Tennessee, this
day of
, 2
.
Notary Public
My commission expires on the
, 2
.
day of
SEAL
State of Tennessee
County of
On this
day of
, before me a notary
, 2
.
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
, 2
My commission expires on the
day of
.
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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