KANSAS DEPARTMENT OF REVENUE
MISCELLANEOUS TAX
915 SW HARRISON ST.
TOPEKA, KANSAS 66612-1588
Web site:
Email: miscellaneous.tax@kdor.ks.gov
Bond No.:
_________________
(Bond will not be accepted without
Phone: (785) 368-8222
Fax: (785) 291-3968
number)
TOBACCO PRODUCTS DISTRIBUTOR’S TAX BOND
KNOW ALL MEN BY THESE PRESENTS: THAT
__________________________________________________________________
with main
(Principal)
office location at _______________________________________________________________________________________
as Principal, and the
(Street Address)
(City)
(State & Zip Code)
_______________________________________________________________________________________________
a corporation authorized to
(Surety Company Name)
transact business in Kansas, as surety, are held and firmly bound unto the STATE OF KANSAS in the penalty sum of
___________________________ thousand dollars ($______________________), lawful money of the United States, to the payment of which, well
thousand dollars
and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, assigns and successors firmly by these presents.
Whereas, the above-named principal, a LICENSED DISTRIBUTOR OF TOBACCO PRODUCTS within the provisions of K.S.A. 79-3374, is
authorized to distribute tobacco products at its licensed location at:
_________________________________________________________________________________________________________________________
(Street Address)
(City)
(State)
and is required by such law to comply with all the provisions of said law together with the rules and regulations pursuant thereto, as adopted by the
Director of Taxation and to make such reports and furnish such information as the Director of Taxation may require, to said Director at his office in
Topeka, Kansas; and to further pay all taxes due and owing the State of Kansas as provided in said Kansas Tobacco Products Law. The forfeiture of
any Distributor’s Bond shall be in an amount equal to all such taxes, penalty and interest owing the State of Kansas.
NOW, THEREFORE, The condition of this obligation is such that if the above-named principal shall faithfully comply with all the provisions of
K.S.A. 79-3374, together with the rules and regulations promulgated by the Director of Taxation pursuant thereto, then this obligation shall be void
and of no effect; otherwise it shall be and remain in full force and effect. Said principal hereby authorizes employees of the Kansas Department of
Revenue to disclose to the surety herein a statement of account relating to the tax guaranteed by this bond.
This bond is effective on and after the
_______________ day of ______________________________________, ____________.
day of
(Year)
Witness our hands at
Witness our hands at ______________________________, Kansas, this _________________ day of __________________________, _________
, Kansas, this
day of
(Year)
______________________________________________________
(Principal)
By
____________________________________________________
(Indicate Position: President, Vice-President, Partner, Owner)
______________________________________________________
(Surety)
______________________________________________________
SEAL
(Surety Address)
______________________________________________________
(Surety Company Phone Number)
By
____________________________________________________
(Surety Signature)
Its
____________________________________________________
(Bond shall be accompanied by power of attorney for attorney-in-fact. A
Kansas licensed agent of the surety must countersign.)
(Extract from K.A.R. 92-17-5)
Any surety on a bond furnished by a tobacco products distributor as provided herein shall be released and discharged from any and all liability to the state accruing
on such bond after the expiration of sixty days from the date upon which such surety shall have lodged with the director a written request to be released and
discharged, but this provision shall not operate to relieve, release, or discharge the surety from any liability already accrued or which shall accrue before the expiration
of the sixty-day period.
TB-85
(Rev. 6/13)