Free DR 157 R. 05-05.indd - Florida

MAIL TO: CENTRAL REGISTRATION - FUEL UNIT FLORIDA DEPARTMENT OF REVENUE PO BOX 6480 TALLAHASSEE, FL 32314 - 6480

Fuel Tax Surety Bond

DR-157 R. 05/05

Please complete and submit an original bond form for each fuel product type or taxable pollutant. An applicant cannot be issued a fuel license by the Department of Revenue until the proper security is submitted. An importer's bond is required in addition to a wholesaler's bond pursuant to Rule 12B-5.030, F.A.C. If further information is needed, please contact Central Registration at 850-488-4772. State of ____________ County of _________________________ bond number ______________________________ We, _______________________________________, as principal , and _____________________________________ ,
(name of principal) (name of surety)

as surety, are bound to the Florida Department of Revenue on behalf of the State of Florida, in the sum of $___________________________ for the payment of which we bind ourselves, our successors and assigns, heirs, and personal representatives, jointly and severally. Principal acknowledges that _______________ is engaged in business which is subject to the Florida Statute
(he, she, it)

identified below: (Please check the appropriate box.) ( ( ( ) Motor fuel pursuant to Chapter 206, F.S. ) Diesel fuel pursuant to Chapter 206, F.S. ) Aviation fuel pursuant to Chapter 206, F.S. ( ( ( ) Pollutants tax pursuant to Chapter 206, F.S. ) Importer's bond pursuant to section 206.051, F.S. ) Alternative fuel pursuant to Chapter 206, F.S.

THE CONDITION OF THIS BOND is that if the principal faithfully complies with the Florida statutory tax provisions regarding such business of the principal then this bond is void; otherwise it remains in force. The surety agrees that if the surety wishes to cancel this bond, notification must be submitted in writing to the Department of Revenue. The bond will be cancelled sixty (60) days after the Department receives notification. The surety is liable for acts committed by the principal and covered by the terms of the bond until it is cancelled. This bond shall be effective as of the ________ day of __________________________, _____
(month) (year)

Signed this _______ day of ________________ , ______ .
(month) (year)

For DOR Use Only
Accepted this _____ day of _____________ , _____ .
(month) (year)

As Principal By ________________________________________
(Principal's name)

As Surety By ________________________________________
(Surety's name)

Florida Department of Revenue
By __________________________________________
Name

________________________________________
(Surety's FEIN)

________________________________________
(Surety's address)

_____________________________________________
Title

________________________________________
(City, State, ZIP)

By ________________________________________
As Attorney-In-Fact and Florida Resident Agent for Surety

Account Number: _______________________________

(Authority of Attorney-In-Fact and Florida Resident Agent must be attached)