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847C:08 30 13
2014 Alaska Operator Surety Bond
847C
AS 05.15.122(b)(5)
Bond Number:
In order that
, (Operator) may obtain or renew a Games of Chance and Skill Operator License for the
State of Alaska,
, (Surety), agrees to be obligated, as surety, to the State of Alaska, for the sum of
thousand dollars ($____________________),
as the bond as required by AS 05.15.122.
The Above obligations shall remain in effect until the Operator pays all fees, interest and penalties due the State of Alaska as required under AS 05.15, and
all net proceeds, including interest due the authorizing permittee by the Operator under the various tax, licensing, and gaming laws of the State of Alaska.
The above obligations commence upon issuance of the Operator License and will then continue for two years after the expiration of the license. Liabilities
that arise during the period to which the bond applies shall be covered under this bond.
__________________________,
IN WITNESS WHEREOF, the surety has affixed its hand and seal this ____________________ day of
Select
Select
_____.
20
12
PRINCIPAL (Applicant)
SURETY
Name:
Name:
Signature:
Address:
Title:
Attorney-in-Fact:
Agency Name:
THIS BOND IS NOT VALID UNTIL SIGNED
BY BOTH PRINCIPAL AND SURETY
Address:
Resident Agent:
Note: Surety’s Power of Attorney Must be Attached
(Surety Seal)
847C
Mail to: Alaska Department of Revenue, PO Box 110420, Juneau AK 99811-0420
0405-847C Rev 08/30/13