Fillable Form Cig-2 - State Form 50838 - Cigarette Tax Stamps Payment Bond printable pdf download

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Bond Number

Form CIG-2

State Form 50838

Cigarette Tax Stamps Payment Bond

(R/ 02-02)

Surety bond given by

Name of Principal

Street Address

City-Town of

, County of

, and State of

Name of City or Town

Name of County

, as principal, and

Name of State

Zip Code

Name of Surety

, as surety, to the State

Street Address

City

State

Zip Code

of Indiana in the sum of

Dollars, for the payment of which, we bind o urselves, our heirs, executors,

administrators, and assigns.

The above principal,

, has applied for, and subject to

Name of Principal

the execution of a bond as provided by law, has obtained a Cigarette Tax Registration Certificate to engage in a business as defined in

Indiana Code 6-7-1-1 entitled “ Indiana Cigarette Tax Law,” and all acts and regulations amendatory, thereof and supplemental thereto,

now in force or which may hereafter be enacted, imposing certain duties, obligations, and liabilities upon said principal, the provisions of

which act and all acts amendatory thereof and supplemental thereto being by reference made a part hereof.

NOW THE CONDITION OF THIS OBLIGATION IS SUCH,

Whereas the above named and bounden

Name of Principal

has been granted a Certificate of Registration by the State of Indiana as a Distributor of Cigarettes, and as such is an agent of the State of

Indiana, in accordance with Indiana Code 6-7-1-17, as amended, and is desirous of purchasing cigarette tax stamps, as defined in the

above Indiana Code, as amended, to be paid for within thirty days after date of purchase as provided in the above Indiana Code as

amended.

Now if the said

Name of Principal

shall, within thirty (30) days from the date of purchase of said cigarette tax stamps pay to the Indiana Department of Revenue the total

amount of tax represented by said stamps, less any discount that may be allowed by statute, this obligation on that purchase shall be null

and void, otherwise to be and to remain in full force and virtue in law.

Further: If the principal does not pay for the purchase of said cigarette tax stamps, when required by statute, the surety herein upon written

notice, will forthwith make payment of any liability as set forth above, not to exceed the penal sum specified herein:

This obligation is absolute and unconditional in that liability of the surety is not contingent upon pursuit of the principal, or assets of the

principal, or any remedy against said principal, its properties, securities, or interests whatever:

Said surety hereby waives all right of protest or contest in its own behalf, or on behalf of said principal for any reason whatever.

This bond shall be effective as to all purchases made on or after

, 20

for the term ending midnight the

day of

, 20

IN WITNESS WHEREOF, we have set our hands and seals this

day of

, 20

Principal

Attest:

Owner or President

Secretary of Corporation

Surety

Attorney in Fact

STATE OF

SS:

COUNTY

Before me, the undersigned, a Notary Public within and for the County and State aforesaid, this

day of

, 20

, personally appeared

(Owner or President of Principal)

and acknowledged the execution of the foregoing hand.

Witness my hand and seal this date.

Notary Public

My commission expires

Form Cig-2 - State Form 50838 - Cigarette Tax Stamps Payment Bond

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