Form Surety-Bond Income Tax Withholding Surety Bond

County State of dollars ($ ) for the payment of which we jointly and severally bind ourselves our heirs administrators executors and assigns rmly by this obligation Notary Public State State Zip Code Zip Code "For Of ce Use Only" Address Address of Legal Residence County Of INCOME TAX WITHHOLDING SURETY BOND My Commission Expires Name of Principal Name of Surety Company named known to me to be the same person named in and who executed the above obligation as Principal and acknowledged to me that he executed this obligation OFFICE OF STATE TAX COMMISSIONER SFN 59895 (Rev 5 2011) On this day of personally appeared before me the above Principal Signature Signature of Authorized Agent for Surety Company Signed this day of State of The original of this document must be returned to the Of ce of State Tax Commissioner We agree that as a condition of the issuance or reinstatement of the income tax withholding account or release of any corporate of cer or LLC governor/manager from personal liability for the tax penalty and interest that may become due on this account of the principal or upon demand by the Tax Commissioner a Surety Bond must be led in the Of ce of the State Tax Commissioner by the Principal The Bond is conditioned to secure the prompt ling of true reports and the full payment of any and all income tax withholding penalty and interest that may hereafter accrue and become payable under the sales and use tax laws of the State of North Dakota We further agree that if the Principal shall le all reports required by the income tax withholding laws and make full payment of any and all income tax withholding taxes which may accrue and become payable to the State of North Dakota under the provisions of the income tax withholding laws of the State of North Dakota then this obligation shall be null and void Otherwise this obligation shall remain in full force and effect We the above named are held and rmly bound to the State of North Dakota in the penal sum of