Form Excises 2 Excise Tax Bond printable pdf download

Rev. 9/15

Massachusetts

Form Excises 2

Department of

Excise Tax Bond

Revenue

Check applicable licensee’s excise bond:

Aircraft (Jet) Fuel — Chapter 64J

Cigarette — Chapter 64C

Know all men by these presents, that we, ___________________________________________________________________

of ____________________________________________ , in the county of _________________________________________

and state of _____________________________________ , as principal, and the ___________________________________

_______________________________________________________________________ a corporation duly organized and existing

under the laws of the state of _____________________________________________________________________________

and having offices and usual place of business at _____________________________________________________________

in the Commonwealth of Massachusetts, as surety, are held and firmly bound unto the Commonwealth of Massachusetts in the

penal sum of _______________________________________________________ dollars ($ _________________________),

for the payment of which, well and truly to be made, we and each of us bind ourselves, our heirs, executors, administrators,

successors and assigns, jointly and severally, firmly by these presents.

The condition of this obligation is such that _______________________________________________________________

Whereas, said principal has made application for a license as ___________________________________________________

____________________________________________________________________________________________________

under the provisions of Chapter 62C, Section 67 of the General Laws.

Now, therefore, if said principal has been granted the license(s) applied for and if the principal shall comply with all the provisions

of such laws under which he is licensed, including payment of all excise taxes, interest, penalties or forfeitures as prescribed in

accordance with the provisions of Chapter ____________________________ of the General Laws, then this obligation shall

be void; otherwise, it shall be and remain in full force and effect.

Provided, however, that all obligation upon this bond shall cease at midnight on December thirty-first, two thousand and

_____________ for all licenses except for such persons licensed under Chapter 64C, which shall cease on June thirtieth,

two thousand and ______________________________ except as to such liability as shall have accrued prior thereto, covering

the period from ________________________________ 20 _______ to the date the license for which this bond is filed, is

suspended or revoked or otherwise cancelled.

In witness whereof, the said principal and the said surety have affixed their corporate seals and caused these presents to be

signed in their behalf by their duly authorized officers this ________________ day of ____________________ 20 ______.

__________________________________________________

Principal

Corporation Seal

By __________________________________________________

Principal

Title

__________________________________________________

Surety

Corporation Seal

By __________________________________________________

Title

Surety

Mail to: Massachusetts Department of Revenue, PO Box 7012, Boston, MA 02204

This form has been approved by the Commissioner of Revenue and may be reproduced.

Form Excises 2 Excise Tax Bond

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