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BOND NO.
A-133: SURETY BOND
I/we of as
(Legal Name) (City and State)
Principal, and of as a
(Surety) (City and State)
corporation duly licensed and authorized to transact business in the State of Wisconsin, as a Surety, are held and firmly
bound to the Wisconsin Department of Revenue in the sum of $ for which payment we
bind ourselves and our respective heirs, personal representatives, successors, and assigns jointly and severally.
The condition of this obligation is such that the Principal has applied for, or has obtained, a permit to engage in
business subject to taxes according to the provisions of Chapters 66, 71, 77, 78, or 139, of the Wisconsin Statutes and
any amendments thereto and a demand has been made upon the Principal by the Wisconsin Department of Revenue for
security for payment of taxes imposed under those chapters.
The Principal shall fully comply with all of the provisions of the Wisconsin Statutes indicated above, and pay all taxes,
interest, and penalties promptly when due, including taxes, interest, and penalties now due and those which may become
due, then this obligation shall be null and void, otherwise it shall remain in full force and effect.
If the Principal is delinquent in the payment of the taxes imposed under the Wisconsin Statutes indicated above, the
Wisconsin Department of Revenue may, upon ten (10) days notice, recover the taxes, interest, and penalties from the
Surety.
The Surety reserves the right to withdraw as such Surety, except for any liability already incurred or accrued, and
may do so upon giving written notice of such withdrawal to the Wisconsin Department of Revenue; provided, that no
withdrawal shall be effective for any purpose until sixty (60) days have elapsed from and after the receipt of such notice
by the Wisconsin Department of Revenue; and further provided that no withdrawal shall in any way affect the liability of
the Surety arising out of any taxes incurred under the provisions of the Wisconsin Statues indicated above, made by the
Principal prior to the expiration of the sixty (60) days, regardless of whether or not an assessment for tax due has been
levied before the lapse of the sixty (60) days.
Check one: (Only one tax type per surety bond is allowed).
ALCOHOL BEVERAGE CIGARETTE SALES AND USE
TOBACCO/VAPOR PRODUCTS FUEL NONRESIDENT ENTERTAINER*
*6% of the total contract price rounded to the next highest $1,000 amount
The undersigned Principal and Surety have signed and sealed this bond this day of
(Month) (Year)
(Signature of Principal) (Signature of Surety)
(Title) (Title)
Corporate Corporate
(Name of Principal) (Seal) (Name of Surety) (Seal)
(Address) (Address)
(City, State, and Zip Code) (City, State, and Zip Code)
WITNESSED BY: WITNESSED BY:
(Signature) (Signature)
(Title) (Title)
Mail To:
Alcohol, Cigarette, Fuel, and Tobacco/Vapor Sales and Use Tax Bonds Entertainer’s Bonds
Products Bonds Special Procedures Unit 4-SPU Wisconsin Dept of Revenue 3-164
Excise Tax Unit Wisconsin Dept of Revenue PO BOX 8966
Wisconsin Dept of Revenue PO BOX 8901 Madison WI 53708-8966
PO BOX 8900 Madison WI 53708-8901
Madison WI 53708-8900
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