MARYLAND FORM DIRECT WINE SHIPPER BOND 379 Comptroller of Maryland Field Enforcement Division Regulatory and Licensing Section P.O. Box 2999 Annapolis, Maryland 21404-2999 410-260-7314 www.marylandtaxes.com ATT Use Only Approved ______________ Date __________________ Bond Number: ______________ KNOW ALL PERSONS BY THESE PRESENTS, that we ______________________________________________, hereinafter called the Principal, and ________________________________________________, an entity incorporated under the laws of the state of _____________________________ and duly licensed to do business under the laws of the State of Maryland, hereinafter called the Surety, are held and firmly bound unto the State of Maryland in the full and just sum of __________________ DOLLARS, lawful money of the United States of America, to be paid to upon demand to the said State of Maryland, or its assigns, to which payment well and truly to be made and done we bind ourselves, our heirs, personal representatives, administrators, successors, and assigns, jointly and severally, firmly by these presents. WHEREAS, under the provisions of Tax-General Article, � 13-825, Annotated Code of Maryland, the above bounded Principal, upon filing an application for a permit to ship wine directly to consumers in the State of Maryland as a "direct wine shipper" as defined in Article 2B, � 7.5, Annotated Code of Maryland, is required to file concurrently therewith a bond of the character stipulated and in the amount provided for therein, which bond shall be filed with the Comptroller of Maryland. NOW, THEREFORE, the conditions of this obligation are such, that if the above bounded Principal shall promptly file tax returns and reports with the Comptroller of the State of Maryland as required by law, and shall well and truly pay all alcoholic beverage taxes as they become due, which are now or may hereinafter be levied or imposed by the State of Maryland, together with any and all penalties and interest thereon, and shall faithfully comply with all the provisions of the Tax-General Article, Title 5 and Title 13, Annotated Code of Maryland, and all amendments thereof, then this obligation to be void; otherwise, to remain in full force and effect until cancelled in accordance with the provisions of the Tax-General Article. Any cancellation of this bond shall not affect any liability incurred or accrued prior to the termination date. In witness whereof the said Principal has hereunto set its hand and seal and the Surety has caused this instrument to be executed in its name and on its behalf this _____ day of __________________, 20________. TO BE COMPLETED BY SURETY TO BE COMPLETED BY LICENSEE ____________________________________________________________ Name of Surety ____________________________________________________________ Name of Principal ____________________________________________________________ Signature of President/Attorney-In-Fact ____________________________________________________________ Signature of Owner, Partner or Officer Attest: _______________________________________________________ Witness: ______________________________________________________ NOTE: CANCELLATION OF THIS BOND REQUIRES A 60 DAY NOTICE COM-FED/RLS-379 Rev. 02/17 American LegalNet, Inc. www.FormsWorkFlow.com