Form 70XN "Nebraska Motor Fuels Tax Bond Rider" - Nebraska

What Is Form 70XN?

This is a legal form that was released by the Nebraska Department of Revenue - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the Nebraska Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 70XN by clicking the link below or browse more documents and templates provided by the Nebraska Department of Revenue.

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Download Form 70XN "Nebraska Motor Fuels Tax Bond Rider" - Nebraska

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Nebraska Motor Fuels Tax Bond Rider
FORM
70XN
If combined bond, complete schedule on page 2.
1 Nebraska ID Number
2 Federal Employer ID or Social Security
3 Surety Bond Number
4 Was a combined bond issued?
Number
Yes
No
If Yes, complete schedule on page 2.
Name and Legal Address Shown on License or Permit
Principal’s Name and Mailing Address
Name
Name
Street Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
5 Fuel Tax Program(s) Covered by Bond Prior to Amendment
Motor Fuels Tax
Producer
Aircraft Fuels Tax
Compressed Fuel Tax
6 Type of Change Requested (see instructions)
7 Amount of Bond After Amendment
Change in Amount of Bond
Change in Name
8
Effective Date of Change
Change Bond Effective Date __________________________
Change in Ownership
Month
Day
Year
Other ____________________________________________
Change in Form of Ownership
9 Explanation of Changes
Name and Mailing Address of Surety Company
Name and Mailing Address of Agent
Name
Name
Street or Other Mailing Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
Email Address
Phone Number
Email Address
Phone Number
All provisions and conditions of the bond to which this rider is attached remain un-
changed except for the specific changes made by this rider.
The liability of the surety under the bond and under this rider shall not be cumulative.
sign
here
Signature of Principal
Date
Signature of Attorney-in-Fact or Authorized Surety Company Officer
Date
Signature of Agent
Date
Mail this rider to: Nebraska Department of Revenue, PO Box 98904, Lincoln, NE 68509-8904.
3-209-1977 Rev. 9-2021
Page 1
Supersedes 3-209-1977 Rev. 7-2020
PRINT FORM
RESET FORM
Nebraska Motor Fuels Tax Bond Rider
FORM
70XN
If combined bond, complete schedule on page 2.
1 Nebraska ID Number
2 Federal Employer ID or Social Security
3 Surety Bond Number
4 Was a combined bond issued?
Number
Yes
No
If Yes, complete schedule on page 2.
Name and Legal Address Shown on License or Permit
Principal’s Name and Mailing Address
Name
Name
Street Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
5 Fuel Tax Program(s) Covered by Bond Prior to Amendment
Motor Fuels Tax
Producer
Aircraft Fuels Tax
Compressed Fuel Tax
6 Type of Change Requested (see instructions)
7 Amount of Bond After Amendment
Change in Amount of Bond
Change in Name
8
Effective Date of Change
Change Bond Effective Date __________________________
Change in Ownership
Month
Day
Year
Other ____________________________________________
Change in Form of Ownership
9 Explanation of Changes
Name and Mailing Address of Surety Company
Name and Mailing Address of Agent
Name
Name
Street or Other Mailing Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
Email Address
Phone Number
Email Address
Phone Number
All provisions and conditions of the bond to which this rider is attached remain un-
changed except for the specific changes made by this rider.
The liability of the surety under the bond and under this rider shall not be cumulative.
sign
here
Signature of Principal
Date
Signature of Attorney-in-Fact or Authorized Surety Company Officer
Date
Signature of Agent
Date
Mail this rider to: Nebraska Department of Revenue, PO Box 98904, Lincoln, NE 68509-8904.
3-209-1977 Rev. 9-2021
Page 1
Supersedes 3-209-1977 Rev. 7-2020
Instructions
Who Must File. Every licensee with a current
Nebraska Motor Fuels Tax Bond, Form
70, must file this form to
report any changes in the bond.
When and Where to File. This rider must be filed prior to the effective date of any change in an existing bond
or before the date specified by the Nebraska Department of Revenue (DOR) when the DOR requests a change
in an existing bond. The rider must be mailed to the Nebraska Department of Revenue, PO Box 98904, Lincoln,
NE 68509-8904 or sent electronically to the taxpayer’s motor fuels account representative. Please contact DOR to
determine your assigned account representative to whom the forms can be sent and for instructions regarding the
secure submission of the forms.
Email. By entering an email address, the taxpayer acknowledges that DOR may contact the taxpayer by email.
The taxpayer accepts any risk to confidentiality associated with this method of communication. DOR will send
all confidential information by secure email or the State of Nebraska’s file share system. If you do not wish to be
contacted by email, write “Opt Out” on the line labeled “email address.”
New Motor Fuels Tax Bond. This form can only be used to amend an existing bond. All new bonds must be filed on
Nebraska Motor Fuels Tax Bond, Form 70.
Changes on Permits and Licenses. This form cannot be used to change any motor fuels tax permit or
license information.
To correct, terminate, or reinstate a permit or license, send a letter to DOR. A change in either the ownership or
form of ownership of any motor fuels tax permit or license requires cancellation of the old permit or license and
the issuance of a new one.
Specific Instructions
Line 1. Enter the Nebraska ID number that you hold. Do not enter your Social Security number.
Line 2. Enter your federal employer ID number if you hold one. If one has been applied for, enter “applied for.” If
you do not have a federal employer ID number and have not applied for one, enter your Social Security number.
Line 4. Check the appropriate box to show whether the current bond is a combined bond. If it is a combined bond,
you must complete Nebraska Schedule – Combined Motor Fuels Tax Bond Rider on this form.
Name and Address. Enter the names and addresses as currently shown on the bond. A new name or address must
be entered on line 9 with an explanation of the change.
Line 5. Check the appropriate boxes to indicate the motor fuel tax programs covered by the current bond prior
to any changes.
Line 6. Check the appropriate boxes to indicate the changes made in the existing bond. One rider can be used to
make multiple changes in a current bond.
A Form 70XN is not required when only making a change in the location or mailing address.
Line 7. Indicate the surety’s total liability under the bond after the changes take effect.
Line 8. Enter the date that the changes made by the rider take effect. DOR must receive this rider prior to the
effective date of the changes.
Line 9. Give a detailed explanation of the changes being made in the existing bond. Specifically state what provisions
are being changed and the conditions that will be in effect after the changes are made.
For additional information, please contact your account representative at the Nebraska Department of Revenue,
PO Box 98904, Lincoln, NE 68509-8904, or call 800-554-FUEL (800-554-3835), or 402-471-5730. DOR’s website
is revenue.nebraska.gov/motor-fuels.
Nebraska Schedule — Combined Motor Fuels Tax Bond Rider
Amount of Bond
Amount of Bond
Tax Program
As Issued
After Amendment
1
2
3
4 Total of lines 1 through 3. Enter here and on line 7 on page 1 of this form. . .
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