Form 409 "Motor Fuel Tax Qualified Dealer Surety Bond" - Alaska

What Is Form 409?

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

Form Details:

  • Released on October 26, 2016;
  • The latest edition provided by the Alaska 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 printable version of Form 409 by clicking the link below or browse more documents and templates provided by the Alaska Department of Revenue.

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Download Form 409 "Motor Fuel Tax Qualified Dealer Surety Bond" - Alaska

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Motor Fuel Tax
409
Qualified Dealer Surety Bond
Form
Principal Name
Bond Number
Mailing Address
Business Type (Check One)
Corporation
Partnership
City
State
ZIP Code
Sole Proprietor
LLC
Other
We, as principal(s), and
as surety,
(Name of Surety)
a corporation incorporated under the laws of the State of
and authorized to do business
in the State of Alaska, execute this bond, and are held and firmly bound unto the State of Alaska, Department of Revenue, in the
sum of $
, the payment of which we bind ourselves, our executors, administrators,
heirs, assigns, and successors, jointly and severally, firmly by this bond.
The condition of the foregoing obligation is that the above bound principal(s) shall pay when due all motor fuel taxes, penalties
and interest due and to become due and owing to the State of Alaska by said principal during the fiscal year beginning July 1,
and ending June 30,
, under the provisions of the motor fuel tax and licensing laws of the State of Alaska (AS
43.40).
This bond may not be canceled, and furthermore, the liability herein assumed shall continue until the statute of limitations has
expired on all motor fuel taxes due to the State of Alaska of said principal for the fiscal year indicated above.
In witness whereof, the above bound parties have executed this instrument this
day of
, 20
, the name and seal of each party being hereto affixed and is duly signed by its
undersigned representative, if any, pursuant to authority of its governing body.
(seal)
ATTEST:
(Principal)
By:
(Secretary of Principal)
(Authorized Agent)
(seal)
(Surety)
ATTEST:
By:
(Secretary of Surety)
(Authorized Agent)
Mail to: Alaska Department of Revenue, Tax Division, PO Box 110420, Juneau AK 99811-0420
www.tax.alaska.gov • 907.269.6620
0405-409 10-26-16
Motor Fuel Tax
409
Qualified Dealer Surety Bond
Form
Principal Name
Bond Number
Mailing Address
Business Type (Check One)
Corporation
Partnership
City
State
ZIP Code
Sole Proprietor
LLC
Other
We, as principal(s), and
as surety,
(Name of Surety)
a corporation incorporated under the laws of the State of
and authorized to do business
in the State of Alaska, execute this bond, and are held and firmly bound unto the State of Alaska, Department of Revenue, in the
sum of $
, the payment of which we bind ourselves, our executors, administrators,
heirs, assigns, and successors, jointly and severally, firmly by this bond.
The condition of the foregoing obligation is that the above bound principal(s) shall pay when due all motor fuel taxes, penalties
and interest due and to become due and owing to the State of Alaska by said principal during the fiscal year beginning July 1,
and ending June 30,
, under the provisions of the motor fuel tax and licensing laws of the State of Alaska (AS
43.40).
This bond may not be canceled, and furthermore, the liability herein assumed shall continue until the statute of limitations has
expired on all motor fuel taxes due to the State of Alaska of said principal for the fiscal year indicated above.
In witness whereof, the above bound parties have executed this instrument this
day of
, 20
, the name and seal of each party being hereto affixed and is duly signed by its
undersigned representative, if any, pursuant to authority of its governing body.
(seal)
ATTEST:
(Principal)
By:
(Secretary of Principal)
(Authorized Agent)
(seal)
(Surety)
ATTEST:
By:
(Secretary of Surety)
(Authorized Agent)
Mail to: Alaska Department of Revenue, Tax Division, PO Box 110420, Juneau AK 99811-0420
www.tax.alaska.gov • 907.269.6620
0405-409 10-26-16