Form MF-135 (State Form 49169) "Irrevocable Standby Letter of Credit" - Indiana

What Is Form MF-135 (State Form 49169)?

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

Form Details:

  • Released on July 1, 2014;
  • The latest edition provided by the Indiana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form MF-135 (State Form 49169) by clicking the link below or browse more documents and templates provided by the Indiana Department of Revenue.

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Download Form MF-135 (State Form 49169) "Irrevocable Standby Letter of Credit" - Indiana

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MF-135
Indiana Department Of Revenue
S
Letter of Credit
tate Form 49169
(R4 / 7-14)
_____________________________________________
____________________________________________
Applicant's Name
Applicant's License Account Number
Gasoline/Special Fuel
Irrevocable Standby Letter of Credit Number _______________
_________________________________________
____________________________________________
Issuing Bank Name
Address
__________________________________________
____________________________________________
Bank FEIN
Telephone Number
__________________________________________
____________________________________________
Effective Date
Expiration Date
We, _________________________________ , hereby issue an IRREVOCABLE STANDBY LETTER OF CREDIT for the
Issuing Bank
name of _____________________________________________________________________________, in the amount
Applicant's Name and Address
of $ ________________________ ( _____________________________ Thousand and no/100 Dollars) which is available
by the Indiana Department of Revenue draft drawn at sight of ________________________________ bearing the clause
Issuing Bank Name
"drawn under ________________________________________ Letter of Credit for ____________________________"
Issuing Bank Name
Applicant's Name
accompanied by this Letter of Credit and the following:
Statement purportedly signed by an officer of the Indiana Department of Revenue certifying that ___________________
has been served a pre-warrant notice covering nonpayment of ______________ taxes pursuant to _________________
Type of Tax
Indiana Code Reference
plus all applicable penalties and interest due the Indiana Department of Revenue and has failed to provide an acceptable
explanation within the time period for such protests or payment of tax.
A copy of the pre-warrant notice which bears the expiration date of at least five (5) days prior to the date of the draft.
Drawings may be made up to an aggregate amount but not to exceed ________________________________________.
Amount of Letter of Credit
MF-135
Indiana Department Of Revenue
S
Letter of Credit
tate Form 49169
(R4 / 7-14)
_____________________________________________
____________________________________________
Applicant's Name
Applicant's License Account Number
Gasoline/Special Fuel
Irrevocable Standby Letter of Credit Number _______________
_________________________________________
____________________________________________
Issuing Bank Name
Address
__________________________________________
____________________________________________
Bank FEIN
Telephone Number
__________________________________________
____________________________________________
Effective Date
Expiration Date
We, _________________________________ , hereby issue an IRREVOCABLE STANDBY LETTER OF CREDIT for the
Issuing Bank
name of _____________________________________________________________________________, in the amount
Applicant's Name and Address
of $ ________________________ ( _____________________________ Thousand and no/100 Dollars) which is available
by the Indiana Department of Revenue draft drawn at sight of ________________________________ bearing the clause
Issuing Bank Name
"drawn under ________________________________________ Letter of Credit for ____________________________"
Issuing Bank Name
Applicant's Name
accompanied by this Letter of Credit and the following:
Statement purportedly signed by an officer of the Indiana Department of Revenue certifying that ___________________
has been served a pre-warrant notice covering nonpayment of ______________ taxes pursuant to _________________
Type of Tax
Indiana Code Reference
plus all applicable penalties and interest due the Indiana Department of Revenue and has failed to provide an acceptable
explanation within the time period for such protests or payment of tax.
A copy of the pre-warrant notice which bears the expiration date of at least five (5) days prior to the date of the draft.
Drawings may be made up to an aggregate amount but not to exceed ________________________________________.
Amount of Letter of Credit
Unless the Indiana Department of Revenue, is notified in writing to the contrary by ______________________________ ,
Issuing Bank Name
this Letter of Credit, the expiration date, and any future expiration dates shall automatically renew each year for additional
periods of one (1) year. If _____________________elects not to renew this Letter of Credit and the expiration date thereof
Issuing Bank Name
(or any subsequent renewal or extension hereof), __________________ shall notify the Indiana Department of Revenue,
Issuing Bank Name
in writing by certified mail, at least one hundred eighty (180) days prior to the stated expiration date of the bank's
election in that regard, in which event, the Indiana Department of Revenue, shall have the right thereafter until the stated
expiration date to draw upon ______________________________________ in the manner above provided.
Issuing Bank Name
_____________________________ engages with the Indiana Department of Revenue, that all drafts drawn under
Issuing Bank Name
and in compliance with the terms of this Letter of Credit will be duly honored upon delivery of documents as specified if
presented at ________________________________________ on or before ______________________ .
Issuing Bank Address
Expiration Date
Except so far as otherwise stated, this credit is subject to the Customs and Practice for Documentary Credits (2007
Revision), International Chamber of Commerce Publication No. 600.
IN WITNESS WHEREOF, we have hereunto set our hand and seal this _____ day of ________________ , 20 ________ .
_____________________________________
Issuing Bank
By:
_____________________________________
Officer of Bank
Title:
_____________________________________
STATE OF
_________________________
COUNTY OF
_________________________
Before me, the undersigned, a Notary Public within and for the County and State aforesaid, this ______ day of _____________ ,
20_______ personally appeared by _______________________ and acknowledged the execution of the foregoing Letter
Officer of Bank
of Credit.
Witness my hand and seal this date ______________________
Notary Public
My commission expires ________________________________ .
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