Form 04-062 - Fisheries Business Tax Bond
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Alaska Department of Revenue
PO Box 110420
Juneau, AK 99811-0420
Fisheries Business Tax Bond
Principal Name_ _______________________________________ Bond Number
Principal Address ______________________________________
_____________________________________
Business Type (check one):
q Corporation
q Partnership
q Sole proprietor
q LLC
q Other
We, as principal(s), and
as surety,
(Name of Insurance Company)
a corporation incorporated under the laws of the State of ___________________________________
(State of incorporation of surety)
authorized to do business in the State of Alaska, execute this bond and are held and firmly bound unto
the State of Alaska, Department of Revenue, in the sum of $_______________________ for the
(Amount of bond)
payment of which we bind ourselves, our executors, administrators, heirs, assigns, and successors,
jointly and severally, firmly by this bond.
The condition of the foregoing obligation is that the above bound principal(s) shall pay when due all
fisheries assessments, fees and/or taxes, penalties and interest due and to become due and owing to
the State of Alaska by said principal for the calendar year _________________________________
under the provisions of the fish tax, assessments and licensing laws of the State of Alaska.
This bond may not be cancelled and, furthermore, the liability herein assumed is to continue until the
statute of limitations has expired on all fisheries taxes due to the State of Alaska of the aforementioned
principal for the calendar year indicated above and incurred at
(Physical Location of Fisheries Business Operation)
In witness whereof, the above bound parties have executed this instrument this
day
of
, 20 _______ the name and seal of each party being hereto
affixed and is duly signed by its undersigned representative, if any, pursuant to authority of its
governing body.
(seal)
ATTEST:
(Principal)
By:
(Secretary of Principal)
(Authorized Agent)
(seal)
ATTEST:
(Surety)
By:
(Secretary of Surety)
(Authorized Agent)
Webform 04-062 (Rev 02/08)
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