
ATT-21
BOND NO.
JUNE 30, 20 .
(Surety)
this
of
, 20
By
NOTE:
Know all men by these presents that we,
The official or attorney in fact signing for Surety shall attach to the original bond a certified copy of authority or power
to
Audit and Regulatory Section
1800 Century Center Blvd. N.E.
Atlanta, Georgia 30359
Telephone: (404) 417-4870
dna lapicnirP sa ,rotubirtsid occabot elaselohw desnecil a
fo
$
bind the Surety. It shall show that the power is in force and effect at the time of the execution of the bond.
P. O. Box 49728
FAX: (404) 417-4871
(Location)
(Name of Distributor)
(Numeric Amount)(Written Amount)
(Name of Surety)
,
WHEREAS, the Principal does unconditionally guarantee to the Georgia Commissioner of Revenue and the
Department of Revenue, State of Georgia, full payment for all tobacco tax stamps purchased during the fiscal year ending
shall be void; otherwise to remain in full force and effect, with respect to all such tax stamp purchases within the above limits.
and Surety bind themselves and their legal representatives, successors and assigns, jointly and severally.
The condition of the foregoing obligation is as follows:
to the effective date of such cancellation.
NOW, THEREFORE, if the Principal pays for such purchases of tobacco tax stamps when due, then this bond
The Surety may cancel this bond by giving written notice to the Georgia Revenue Commissioner and to the Principal
by certified or registered mail, return receipt requested, in which event the cancellation shall be effective sixty (60) days after the
Georgia Revenue Commissioner and the Principal shall have received such notice, the Surety remaining liable, however, subject
to the terms, conditions and provisions hereof for any purchases or acts covered hereby which may have been committed prior
This bond is given pursuant to an Act approved March 4, 1970 (GA. Laws 1970, p.146) and shall be construed in
conformity therewith.
IN WITNESS WHEREOF, the
(Attorney In Fact)
, as Surety, are held and firmly bound unto the
TOBACCO DISTRIBUTORS TAX STAMP BOND
Department of Revenue
Alcohol & Tobacco Division
(Principal)
(Surety)
has caused this bond to be signed by its Attorney in Fact and its Corporate Seal be hereunto affixed
Georgia Revenue Commissioner and the Department of Revenue of the State of Georgia, in the sum of
for which payment the said Principal
Rev. (12/09)