Free Form AU-432 - New York


File Size: 13.8 kB
Pages: 2
File Format: PDF
State: New York
Category: Tax Forms
Author: X37595
Word Count: 963 Words, 5,545 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.tax.state.ny.us/pdf/2001/petrol/au432_1201.pdf

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Preview Form AU-432
Bond no.

Bond of Distributor of Automotive Fuel
Pursuant to Articles 12-A and 13-A, and under Articles 28 and 29 of the Tax Law KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned
(Name of corporation,

of
partnership, or individual) (Address -- street, city, state, ZIP code)

as principal, and
(Name of insurance company) (Address -- street, city, state, ZIP code)

as surety, being a surety company incorporated under the laws of
(State of incorporation)

and duly authorized to transact business in the State of New York, are held and firmly bound to the People of the State of New York in the sum of dollars ($ ) for which payment well and truly to be made we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, by these presents. WHEREAS, said principal, having a place of business at
(Address -- street, city,

has applied for registration as a distributor of automotive fuel pursuant to Article 12-A of the
state, ZIP code)

Tax Law, or has been registered as such distributor. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that if the principal shall faithfully discharge all duties as such distributor pursuant to Articles 12-A, 13-A, 28, and 29 of the Tax Law and the regulations of the Department of Taxation and Finance thereunder, and all duties as a purchaser or seller of automotive fuel pursuant to Articles 12-A, 13-A, 28, and 29 of the Tax Law and the regulations of the Department of Taxation and Finance thereunder, and shall duly account for and pay over to said Department as required by law all sums due from the principal pursuant to Articles 12-A and 13-A and under Articles 28 and 29 of the Tax Law with respect to automotive fuel, then this obligation to be void, otherwise to remain in full force and effect, subject, however, to the following conditions: 1. The aggregate liability of the surety on account of all defaults occurring during the entire effective period of this bond shall not exceed the amount above stated. This bond may be canceled as to liability for future defaults at any time upon the written consent of the Department of Taxation and Finance, or upon thirty (30) days written notice by the surety to the Department of Taxation and Finance.

2.

Provided, further, the liability of any other person for the amount of taxes not paid shall not release the surety from its obligation under this bond. IN WITNESS WHEREOF, said principal and surety have signed and sealed this instrument this day of , 20 .

Principal

(SEAL)

by

Surety

(SEAL)

by Attest: NOTE: Acknowledgments by both principal and surety on back. Attach current financial statement of surety, and copy of power of attorney for person signing on behalf of surety company.

AU-432 (12/01)

AU-432 (12/01) (back)

SURETY ACKNOWLEDGMENT
State of County of On this day of in the year ) ) ) SS.:

before me personally came

(name of attorney in fact)

to me known,

who, being duly sworn, did depose and say that he/she resides in;
(if the place of residence is in a city, include the street and street number, if any, thereof)

that he/she is the attorney in fact duly appointed of the
(name of corporate surety)

, the corporation described in and which

executed the attached instrument as surety; that he/she knows the seal of said corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by authority of the board of directors of said corporation; and that he/she signed his/her name thereto by like authority. Notary Public My commission expires

ACKNOWLEDGMENT BY PRINCIPAL
INDIVIDUAL ACKNOWLEDGMENT State of County of On this day of in the year before me personally came to me known, to be the person described in the attached bond and that he/she acknowledged to me that he/she executed the same. PARTNERSHIPS/LIMITED LIABILITY PARTNERSHIP ACKNOWLEDGMENT State of County of On this day of in the year before me personally came to me known, who being by me duly sworn, did depose and say that he/she resides at ; that he/she is a partner of , the partnership described in and which executed the attached bond as principal; and that he/she is empowered to and did execute the same for and on behalf of the partnership. ss.:

ss.:

(notary public)

CORPORATE ACKNOWLEDGMENT (AS PRINCIPAL) State of County of ss.:

(notary public)

On this day of in the year before LIMITED LIABILITY COMPANY ACKNOWLEDGMENT me personally came to me known, who being by me duly sworn, did depose and say that State of he/she resides in ; ss.: (if the place of residence is a city include the street and street number, if any) County of that he/she is the (corporate title) On this day of in the year before of the, me personally came (name of corporation) to me known, who being by me duly sworn, did depose and say that the corporation described in and which executed the attached bond he/she resides in ; as principal; that he/she knows the seal of said corporation; that the (if the place of residence is a city include the street and street number, if any) seal affixed to said instrument is such corporate seal; that it was so that he/she is a member or manager of the (name of LLC) affixed by authority of the board of directors of said corporation, and , the limited liability that he/she signed his/her name thereto by like authority. company described in and which executed the attached bond as principal; that he/she is authorized to and did execute the same for and on behalf of the company.
(notary public) (notary public)