FT 462 (11/25/2017)
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH THAT:
WHEREAS, PRINCIPAL wishes to transact fuel related business in the Commonwealth of Virginia as defined in Title 58.1, Chapter 22 of the Code
of Virginia (1950) as amended, and has applied for the license type indicated above to act as such, to be issued by the Commissioner of the
Department of Motor Vehicles pursuant to Title 58.1, Chapter 22 of the Code of Virginia (1950) as amended; and
WHEREAS, pursuant to Title 58.1, Chapter 22 of the Code of Virginia, a bond executed by PRINCIPAL and a surety company licensed to do
business under the laws of the Commonwealth of Virginia must be on file with the Commissioner of the Department of Motor Vehicles in order for
PRINCIPAL to obtain said license; and
WHEREAS, PRINCIPAL and SURETY have entered into this Bond for the purpose of satisfying the bond requirements of Title 58.1, Chapter 22 of
the Code of Virginia;
NOW THEREFORE, if PRINCIPAL shall well and faithfully comply with the provisions of Title 58.1, Chapter 22 of the Code of Virginia, and shall
promptly file true and timely reports of and shall promptly pay any and all fuels taxes which are now or which may hereafter be levied or imposed by
the Commonwealth of Virginia, together with penalties and interest thereon and fines, uncollectible check fees and attorneys fees due from
PRINCIPAL to the Commonwealth of Virginia, beginning with the effective date of this Bond and continuing until this Bond is lawfully terminated, then
the above obligation shall be void, otherwise to remain in full force and effect.
IN WITNESS WHEREOF, This instrument has been duly executed by the above-named PRINCIPAL and SURETY the day and year above written.
(Corporation, Limited Liability Company sign below)
Attest: ______________________________________________________
______________________________________________________ ______________________________________________________
SEAL
(Sole Proprietorship, Partnership, Limited Partnership, and all others sign below with witness(es)
WITNESS
______________________________________________________ ______________________________________________________[SEAL]
______________________________________________________ ______________________________________________________[SEAL]
______________________________________________________ ______________________________________________________[SEAL]
COUNTERSIGNED: (Not Required) ATTEST:
By ____________________________________________________ ______________________________________________________[SEAL]
(Virginia Representative) (Name of Surety Company)
Address ________________________________________________ By __________________________________________________[SEAL]
(Official or Attorney in Fact for Surety Co.)
This Bond shall continue in force from year to year, unless terminated in accordance with the provisions of Title 58.1, Chapter 22 of the Code of
Virginia, as amended. SURETY shall be released and discharged from any and all liability to the Commonwealth accruing under the terms of this Bond
after the expiration of sixty (60) days from the date upon which SURETY shall have lodged with the Commissioner of the Department of Motor
Vehicles written request to be released and discharged from this Bond. Such release and discharge shall not operate to relieve, release or
discharged SURETY from any liability accrued under the Bond at the time of the written request or during the sixty-day period following the lodging of
the written request.
DEPARTMENT OF MOTOR VEHICLES
Approved this _____________ day of _________________________, ________.
(Year)
By __________________________________________________
(Authorized Signature)
NOTE: PRINCIPALS AND SURETY MUST EXECUTE AFFIDAVITS ON THE REVERSE SIDE
FUELS TAX BOND
PURPOSE: Use this form to submit a surety bond to assure the collection of money due to Virginia.
INSTRUCTIONS: Submit completed form to the Fuel Tax Unit at the above address. NOTE: Bond should be executed in quadruplicate.
Original to be filed with Department of Motor Vehicles, duplicate and triplicate for Surety Company, quadruplicate for Principal.
Surety Company's
Bond Number: ________________
Effective Date: ________________
BUSINESS OPERATION TYPE
Aviation Consumer
Distributor Refiner
Blender
Fuel Alcohol Provider
Retailer of Alternative Fuel
Bonded Importer
Occasional Importer
Supplier
Bulk User of Alternative Fuel
Provider of Alternative Fuel
Terminal Operator
KNOW ALL MEN BY THESE PRESENTS, That ______________________________________________________________________________
of _________________________________________, County of __________________________________, State of __________________________
whose principal place of business is located at ______________________________________________________________________, as PRINCIPAL
and ___________________________________________________________________________________ a corporation organized under the laws of
__________________________________, and duly authorized to engage in business in the Commonwealth of Virginia, with its principal office therein
located at ________________________________________________ in the City of _________________________________________, as SURETY,
are held and firmly bound unto the Commonwealth of Virginia in the sum of ______________________________________________________dollars
($ ____________________) lawful money of the United States of America, to be paid to the said Commonwealth of Virginia, to which payment well and
truly to be made, we bind ourselves and each of us, our and each of our heirs, executors, administrators, successors and assigns, jointly and severally,
firmly by these presents. Signed, sealed, and delivered this ______ day of ______________________________________ A. D. ________________
(Name of Principal)
(City or Town)
(Name of Surety)
(Year)
(Name of Principal)
(President)(Secretary)
