Cigarette Tax Stamps Payment Bond {CIG-2}

Form CIG-2 State Form 50838 (R/ 02-02) Bond Number Cigarette Tax Stamps Payment Bond of Name of Principal Street Address Surety bond given by City-Town of Name of State Street Address Name of City or Town , , and State of Name of County , County of Name of Surety City State Zip Code , as principal, and Zip Code of , as surety, to the State of Indiana in the sum of administrators, and assigns. The above principal, Dollars, for the payment of which, we bind o urselves, our heirs, executors, , 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 for the term ending midnight the IN WITNESS WHEREOF, we have set our hands and seals this day of day of , 20 , 20 , 20 , . . Principal Attest: By Owner or President Secretary of Corporation Surety By 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 American LegalNet, Inc. www.FormsWorkflow.com Form CIG-2 (R/ 02-02) Cigarette Tax Stamps Payment Bond License No. (name) (address) Taken and approved by me this day of 20 Administrator American LegalNet, Inc. www.FormsWorkflow.com