COMMONWEALTH OF VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 2901 HERMITAGE ROAD, P O BOX 27491 RICHMOND, VIRGINIA 23261 Surety's Bond No. MALT BEVERAGE MANUFACTURER'S, BOTTLER'S OR WHOLESALER'S BOND Know All Men By These Presents, That , (Name of Principal) (Number, Street or Route) , ' (City, Town or Post Office and Zip Code) hereinafter referred to as Principal (Va. A.B.C. Board License No. and (Name of Surety) ), , , (Mailing Address) hereinafter referred to as Surety, incorporated under the laws of the State of and duly authorized to do business in Virginia, with , in the said State are its home office in the City of held and firmly bound unto the Virginia Alcoholic Beverage Control Board (the Board), Department of Alcoholic Beverage Control of The Commonwealth of Virginia in the sum of dollars ($ ), in lawful money of the United States of America, to be paid to the said Board, to whom payment well and truly to be made we do hereby bind ourselves, jointly and severally, our successors and assigns, firmly by these presents. WHEREAS, The Principal is a manufacturer, bottler or wholesaler, as defined is Section 4.1-239 of the Code of Virginia, licensed by the Virginia Alcoholic Beverage Control Board to sell beer and beverages to licensed retailers; and, WHEREAS, Section 4.1-239 of the Code of Virginia provides that on or before the tenth day of each month each manufacturer, bottler, wholesaler or other person selling beer or beverages in Virginia shall file with the board reports on forms prescribed by the Board showing the quantity of all beer and beverages manufactured, bottled or sold during the preceding calendar month, the amount of tax, if any, for which such person is liable, and containing such other information as the Board may require, and at the same time shall pay to the Board all such excise taxes chargeable or assessable under the provisions of Chapter 4.1 of Title 4.1 of the Code of Virginia. NOW, THEREFORE, the condition of the foregoing obligation is such that if the said Principal shall file on or before the tenth day of each month reports as required by Section 4.1-239 of the Code of Virginia, as amended, showing the quantity of all beer and beverages sold during the preceding calendar month, the amount of tax thereon, penalty and interest, if any, for which such Principal is liable and containing such other information as required, and on or before the tenth day of each month shall pay to the Board all such taxes, penalties and interest chargeable or assessable against such Principal, then this obligation shall be null and void, otherwise it shall remain in full force and effect; provided, however, that any surety may cancel its obligation hereunder upon thirty days' written notice by registered mail given by the said Surety to the Board, such cancellation to be prospective in operation only. This agreement shall be construed in accordance with the laws of the commonwealth of Virginia. Witness the following signature and seals this day of ,20 (Seal) (Principal) Witness or Attest: By (Signature and Title) Countersigned by: (Seal) (Surety) (Resident Agent of Virginia) (Number and Street) By (City, Town or Post Office) (Attorney-in-Fact) (This bond must be accompanied by a verified copy of the authority of the person executing the same to do so on behalf of the corporate surety.) American LegalNet, Inc. www.FormsWorkflow.com ACKNOWLEDGEMENT OF PRINCIPLE State of CITY/COUNTY OF The foregoing 20 , by , to wit: instrument was acknowledged before this day of , the (Name of Person signing on behalf of Principal) (Principal), Principal) , of (title) (Corporate on behalf of the principal, in my My jurisdiction commission or other name of aforesaid. expires Notary Public AFFIDAVIT AND ACKNOWLEDGEMENT OF SURETY COMMONWEALTH OF VIRGINIA , to-wit: CITY/COUNTY OF I, the undersigned notary public, do certify that personally appeared before me in the jurisdiction aforesaid and made oath that he is (Name of Surety), that attorney-in-fact of the he is duly authorized thereby to execute in its behalf (a) certain (payment) (performance) Dollars bond(s) in the sum of ), dated the ($ day of , wherein the , 20 are Commonwealth of Virginia and is Principal and Obliges, is Surety, by virtue of a certain power of attorney and recorded in the Clerk's Office of the made by said Surety, dated Virginia, in the Deed Book , page Circuit Court of that the said power of attorney has not been revoked; that the said Surety is legally : qualified to do business in Virginia; and, that the said thereupon, in the name and on behalf of the said Surety, acknowledged the aforesaid bond(s) as its act and deed. Given under my hand this day of , 20 , My commission expires: Notary Public American LegalNet, Inc. www.FormsWorkflow.com