Free F-666-21(A) - Indiana

VERIFIED APPLICATION FOR RELEASE OF CASH BOND
State Form 50300 (7-01) Approved by State Board of Accounts, 2001

Department of Natural Resources / Division of Forestry

Comes now ______________________________________ (Licensee) of ______________________________ __________________________________________________________________________________________ a duly licensed timber buyer and, first being duly sworn upon his oath, makes this verified application to the Forestry Division, Indiana Department of Natural Resources, for release of cash bond and, in support of such application deposes and says: 1. That on or about the __________ day of __________________ 20____, the Licensee was issued a Timber Buyer's License pursuant to the provisions of Indiana law (I.C. 25-36.5-1-1 et seq.) 2. That the Licensee submitted to the Division of Forestry, on or about the ______ day of ___________, 20___, an approved cash bond in the amount of ___________________________________________________ ($ ) Dollars. 3. The Licensee has ceased to operate or otherwise engage in activities of Timber Buyer and now desires to terminate said License (unless otherwise previously terminated) have the said bond released. 4. That Licensee is not in violation of the Timber Buyer's Licensing Act as found in I.C. 25-36.5-1-1 et seq. and is not in default to any citizen of the State of Indiana for money due under such law. 5. That the statements and representations are true and correct to the best of the knowledge of the undersigned, under the penalties of perjury.

In witness whereof the Licensee set his/her hand this _______ day of _________________________, 20____.

Signature_____________________________________ Printed Name (LICENSEE)___________________________________

State of County of Being duly sworn upon this oath, deposes and says that he is the person who signed the above request and says all statements in the above request are true, and said statements are made for the purpose of releasing a certificate of deposit obtained to meet bonding requirements for a Timber Buyers License in the State of Indiana. Subscribed and sworn to before me, a Notary Public, this ______ day of ________________________, 20_____.

_____________________________________ Notary Public

My Commission Expires:_________________________