MISSOURI DEPARTMENT OF PUBLIC SAFETY
DIVISION OF ALCOHOL AND TOBACCO CONTROL
CORPORATE BOND (INTOXICATING LIQUOR, WINE & 5% BEER TAX)
BOND NUMBER
TYPE OR USE ONLY BLACK INK TO COMPLETE THIS APPLICATION
NAME OF CORPORATION, SOLE OWNER, PARTNERSHIP OR LLC
Know by these present, that
OF THE CITY OF COUNTY OF STATE OF
as Principal, and
NAME OF STATE
a corporation duly organized and existing under and by virtue of the laws of the State of , and
authorized to become sole surety on bonds in the State of Missouri, as surety, are held and firmly bound into the State of
BOND AMOUNT
Missouri, in the full and penal sum of
lawful money of the United States, for payment of which
will and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and
severally, firmly by these present.
Whereas, the said Principal has been licensed by the Supervisor of Alcohol and Tobacco Contol of the State of Missouri, as
NAME OF MANUFACTURER OR SOLICITOR
of the Liquor Control Act of the State of Missouri, and acts amendatory thereto, at
STREET
IN THE CITY OF COUNTY OF STATE OF
FOR A TERM BEGINNING THE AND CONTINUING UNTIL THE
day of ,Year day of ,Year
Now therefore, the conditions of this obligation are such that, if the Principal shall pay to the Director of Revenue all moneys which shall
become due from or payable by said Principal under the provisions of Sections 311.520, 311.550, 311.553, 311.554, 311.557, 311.561,
311.580 and 311.600, RSMo, and if the Principal shall fully comply with the provisions of said Sections, as amended and supplemented,
and with the Rules and Regulations of the Supervisor of Alcohol and Tobacco Control made pursuant thereto, then this obligation shall be
void; otherwise to remain in full force and effect. This bond is given and received under the express conditions that if Surety shall so elect,
this bond may be terminated by giving thirty (30) days' notice in writing to Principal named herein and to the Supervisor of Alcohol and
Tobacco Control of Missouri. Provided that, in the event of such cancellation, the Surety shall, upon surrender of this bond and its release
from all liability thereunder, refund the premium paid, less a pro rata part thereof, for the time this bond shall have been in force.
SIGNATURE OF OWNER, MANAGING OFFICER, OR PARTNER DATE SIGNATURE OF PARTNER (IF THERE ARE MORE THAN ONE) DATE
SIGNATURE OF PARTNER (IF THERE ARE MORE THAN ONE) DATE SIGNATURE OF PARTNER (IF THERE ARE MORE THAN ONE) DATE
NAME STREET ADDRESS
CITY STATE ZIP CODE PHONE NUMBER FAX NUMBER
SURETY SIGNATURE ATTORNEY IN FACT SIGNATURE
SURETY OR BONDING COMPANY
