Free DR-17B - Florida

Suggested Format for Florida Sales and Use Tax SURETY BOND
State of Florida County of _____________________ SURETY BOND

DR-17B N. 06/07

BOND NUMBER __________________ ______________________________________________________________________________________ , having a place of business in ___________________ , ________________ County, Florida, Certificate of Registration number: ____________ as principal (Certificate Holder), and ______________________________ , a company authorized to conduct and carry on a general surety business in the state of Florida as surety (Surety), are bound to the Florida Department of Revenue on behalf of the state of Florida, in the sum of ____________ Dollars ($ ________ ) for the payment of which the Certificate Holder and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. The Certificate Holder acknowledges that (he, she, it) offers or plans to offer services and/or products subject to tax, discretionary sales surtax, fees, or surcharges imposed by or administered by the Department or Revenue pursuant to Chapter 212, Florida Statutes, and that this bond is conditioned upon compliance by Certificate Holder with the requirements of Chapter 212, Florida Statutes. The Certificate Holder agrees: 1. To timely and faithfully collect and remit applicable taxes, surtaxes, fees and surcharges in a timely manner in accordance with the requirements of Chapter 212, Florida Statutes. 2. If the Certificate Holder is more than 30 days delinquent in the payment of any applicable tax, surtax, fee, surcharge, interest or penalty the Department of Revenue may provide written notice of such delinquency to the Certificate Holder and Surety at the following addresses: Certificate Holder ___________________________________________________ ___________________________________________________ ___________________________________________________ Surety ___________________________________________________ ___________________________________________________ ___________________________________________________

3. Upon written notification by the Department of Revenue of an existing outstanding assessment of any tax, discretionary sales surtax, fees, surcharges, penalty, or interest by the Certificate Holder, the Surety shall have 30 days to pay the Department of Revenue all outstanding assessments, and all costs and attorney's fees, including from appellate proceedings that the Department sustains in collecting on the delinquency or assessment. 4. Surety shall have the right, upon sixty (60) days written notice to the Department and the certificate holder, to cancel this bond. The bond will be cancelled sixty (60) days after the Department receives notification. Surety is liable for acts committed by the principal and covered by the terms of this bond until it is cancelled. SIGNED this ______________ day of _________________ 20________. Surety Company: Serial # of Bond ___________________________________ Company ________________________________________ Address __________________________________________ __________________________________________________ Telephone Number ________________________________ By: __________________________________________________ As Attorney in Fact Principal: by _____________________________