Form Ttb F 5210.12 - Deferral Bond-Tobacco Products
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1
2DEPARTMENT OF THE TREASURY
Alcohol and Tobacco Tax and Trade Bureau
DEFERRAL BOND-TOBACCO PRODUCTS
(Puerto Rico)
(Fill in duplicate. See instructions on page 2)
PRINCIPAL (See instructions 2, 3, and 4)
ADDRESS OF BUSINESS OFFICE (Number, Street, City, State,
ZIP Code)
SURETY (or Sureties)
AMOUNT OF BOND
EFFECTIVE DATE
KIND OF BOND (Check applicable box)
ORIGINAL
STRENGTHENING
SUPERSEDING
KNOW ALL MEN BY THESE PRESENTS. That we, the above
WHEREAS, under the provisions of applicable regulations per-
named principal and surety, are held and firmly bound unto the
taining to the deferred payment of taxes in Puerto Rico with re-
United States of America in the above-named amount, lawful
spect to tobacco products shipped to the United States, the prin-
money of the United States, for the payment of which we bind
cipal must give bond to secure the deferred payment of taxes
ourselves, our heirs, executors, administrators, successors, and
computed with respect to such tobacco products; and
assigns, jointly and severally, firmly by these presents.
WHEREAS, pursuant to such regulations, the principal gives this
This bond will not in any case be effective before the above
bond to secure the deferred payment of the taxes imposed by 26
named date, but if accepted by the United States it will be effec-
U.S.C. 7652(a)(1) which is equal to the rates of tax set forth in 26
tive according to its terms on and after that date without notice to
U.S.C. 5701, on tobacco products of domestic manufacture.
the obligors: provided, that if no date is inserted in the space
NOW THEREFORE, the condition of this bond is such that if the
provided there for, the date of execution will be the effective
principal must pay, or cause to be paid, to the United States, at
date.
the time and in the manner prescribed in the aforesaid regula-
WHEREAS, the principal intends to remove from the above
tions, the full amount of taxes with respect to the tobacco prod-
specified factory tobacco products of Puerto Rican manufacture
ucts (equal to the tax imposed by 26 U.S.C. 5701, on tobacco
for shipment to the United States; and
products of domestic manufacture) which have been computed
pursuant to said regulations, then this obligation must be null and
WHEREAS, under the provisions of 26 U.S.C. 7652(a)(1), there
void; but otherwise it must remain in full force and effect.
is imposed on all tobacco products of Puerto Rican manufacture
coming into the United States and withdrawn for consumption or
We, the obligors, for ourselves, our heirs, executors, administra-
sale a tax equal to the Internal Revenue tax imposed in the United
tors, successors, and assigns, do further covenant and agree
States upon like tobacco products of domestic manufacture; and
that the total amount of this bond must be available for satisfac-
tion of any liability incurred under the terms and conditions of
WHEREAS, under the provisions of 26 U.S.C.7652(a)(2), the
this bond, and that upon the breach of any of the covenants of
tax imposed by 26 U.S.C.7652(a)(1), may be paid before ship-
this bond, the United States may pursue its remedies against the
ment from Puerto Rico; and
principal or surety, independently, or against both jointly, and the
said surety hereby waives any right or privilege it may have of
WHEREAS, the principal desires the privilege of paying in Puerto
requiring, upon notice, or otherwise, that the United States must
Rico, on the basis of semimonthly returns, the tax computed on
first commence action, intervene in any action of any nature
tobacco products of Puerto Rican manufacture removed for ship-
whatsoever already commenced, or otherwise exhaust its reme-
ment to the United States; and
dies against the principal.
Witness our hands and seals this _____________________________ day of ____________________________ , 20 ___________
Signed, sealed, and delivered in the presence of-
(SEAL)
(SEAL)
(SEAL)
(SEAL)
Page 1 of 2
TTB F 5210.12 (05/2007)
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