Form B-A-30 "Tobacco Products Cigarettes Surety Bond" - North Carolina

What Is Form B-A-30?

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

Form Details:

  • Released on February 1, 2020;
  • The latest edition provided by the North Carolina 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 B-A-30 by clicking the link below or browse more documents and templates provided by the North Carolina Department of Revenue.

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Download Form B-A-30 "Tobacco Products Cigarettes Surety Bond" - North Carolina

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B-A-30
4
Tobacco Products Cigarettes
Web-Fill
PRINT
CLEAR
Surety Bond
2-20
BOND NO.
______________________________________________________________________________________________, (“Principal”) and
___________________________________________________________________________________________________, (“Surety”),
authorized to engage in business as a surety in the State of North Carolina, are obligated to the State of North Carolina, in the sum of USD
_______________________________________________________________ (US$_________________________). We jointly and
severally obligate heirs, executors, administrators, successors, and assigns for the payment of this amount.
Principal is engaged or intends to engage in activities where the Secretary of Revenue of the State of North Carolina is requiring a bond
in accordance with N.C. Gen. Stat. § 105-113.13.
The terms for this bond are as follows:
1. Principal shall file reports, pay all taxes, and otherwise comply with all applicable laws, rules, and regulations relating to licensed
activities for the sale, use, and distribution of cigarettes in the State of North Carolina. This includes but is not limited to liability
incurred under Article 2A and Article 9 of Chapter 105 of the North Carolina General Statutes.
2.
The bond is continuing and effective for acts or omissions occurring on or after the ______ day of _________________, 20______.
3. Surety may be released from future liability when Principal or Surety provide at least sixty (60) days’ written notice by certified
mail to the State of North Carolina, through its agent, the Secretary of Revenue at the following address: ATTN: Excise Tax
Division, Licensing and Bonding Unit, P.O. Box 25000, Raleigh, NC 27640. If the notice is given by an agent of Surety, the notice
must be accompanied by a power of attorney. Surety is not released from any liability which accrues before Surety is released,
regardless of when the liability is discovered. Notice, as provided for in this paragraph, is a condition precedent to the release of
liability under this bond, and any attempted cancellation inconsistent with this paragraph is void, and this bond remains in effect.
4.
This bond extends to any place of business where Principal is required to obtain a license required under N.C. Gen. Stat. § 105-
113.12.
5. If Principal or Surety fail to fulfill any term of this bond, the State of North Carolina may make a claim on the bond and pursue all
available remedies.
Signed, sealed, and delivered this ______ day of ____________________, 20______.
SURETY NAME
PRINCIPAL NAME
SURETY REPRESENTATIVE SIGNATURE
PRINCIPAL REPRESENTATIVE SIGNATURE
X
X
SURETY REPRESENTATIVE PRINTED NAME
PRINCIPAL REPRESENTATIVE PRINTED NAME AND TITLE
As Attorney in Fact
SURETY
PRINCIPAL
NOTARY (IF NO SEAL FOR PRINCIPAL)
Surety declares that the
Principal declares that its seal is
Principal has no seal; your signature MUST be notarized below.
surety’s seal is affixed to this form.
affixed to this form.
State of ________________________ County of ________________________ .
This instrument was acknowledged before me on _____________________ (date)
by
______________________________ (name of Principal Representative).
SURETY
PRINCIPAL
SEAL
SEAL
NOTARY
SEAL
Signature of Notary Public
Mail to: North Carolina Department of Revenue, Attention: Licensing and Bonding Unit
1429 Rock Quarry Road, Suite 105, Raleigh, NC 27610
B-A-30
4
Tobacco Products Cigarettes
Web-Fill
PRINT
CLEAR
Surety Bond
2-20
BOND NO.
______________________________________________________________________________________________, (“Principal”) and
___________________________________________________________________________________________________, (“Surety”),
authorized to engage in business as a surety in the State of North Carolina, are obligated to the State of North Carolina, in the sum of USD
_______________________________________________________________ (US$_________________________). We jointly and
severally obligate heirs, executors, administrators, successors, and assigns for the payment of this amount.
Principal is engaged or intends to engage in activities where the Secretary of Revenue of the State of North Carolina is requiring a bond
in accordance with N.C. Gen. Stat. § 105-113.13.
The terms for this bond are as follows:
1. Principal shall file reports, pay all taxes, and otherwise comply with all applicable laws, rules, and regulations relating to licensed
activities for the sale, use, and distribution of cigarettes in the State of North Carolina. This includes but is not limited to liability
incurred under Article 2A and Article 9 of Chapter 105 of the North Carolina General Statutes.
2.
The bond is continuing and effective for acts or omissions occurring on or after the ______ day of _________________, 20______.
3. Surety may be released from future liability when Principal or Surety provide at least sixty (60) days’ written notice by certified
mail to the State of North Carolina, through its agent, the Secretary of Revenue at the following address: ATTN: Excise Tax
Division, Licensing and Bonding Unit, P.O. Box 25000, Raleigh, NC 27640. If the notice is given by an agent of Surety, the notice
must be accompanied by a power of attorney. Surety is not released from any liability which accrues before Surety is released,
regardless of when the liability is discovered. Notice, as provided for in this paragraph, is a condition precedent to the release of
liability under this bond, and any attempted cancellation inconsistent with this paragraph is void, and this bond remains in effect.
4.
This bond extends to any place of business where Principal is required to obtain a license required under N.C. Gen. Stat. § 105-
113.12.
5. If Principal or Surety fail to fulfill any term of this bond, the State of North Carolina may make a claim on the bond and pursue all
available remedies.
Signed, sealed, and delivered this ______ day of ____________________, 20______.
SURETY NAME
PRINCIPAL NAME
SURETY REPRESENTATIVE SIGNATURE
PRINCIPAL REPRESENTATIVE SIGNATURE
X
X
SURETY REPRESENTATIVE PRINTED NAME
PRINCIPAL REPRESENTATIVE PRINTED NAME AND TITLE
As Attorney in Fact
SURETY
PRINCIPAL
NOTARY (IF NO SEAL FOR PRINCIPAL)
Surety declares that the
Principal declares that its seal is
Principal has no seal; your signature MUST be notarized below.
surety’s seal is affixed to this form.
affixed to this form.
State of ________________________ County of ________________________ .
This instrument was acknowledged before me on _____________________ (date)
by
______________________________ (name of Principal Representative).
SURETY
PRINCIPAL
SEAL
SEAL
NOTARY
SEAL
Signature of Notary Public
Mail to: North Carolina Department of Revenue, Attention: Licensing and Bonding Unit
1429 Rock Quarry Road, Suite 105, Raleigh, NC 27610